Remote Senior Compliance Coding Analyst - Emergency Medicine

What we do here changes the world. UTHealth Houston is Texas’ resource for healthcare education, innovation, scientific discovery, and excellence in patient care. That’s where you come in.

Once you join us you won't want to leave. It’s because we reward our team for the excellent service they provide. Our total rewards package includes the benefits you’d expect from a top healthcare organization (benefits, insurance, etc.), plus:  

• 100% paid medical premiums for our full-time employees  
• Generous time off (holidays, preventative leave day, both vacation and sick time – all of which equates to around 37-38 days per year) 
• The longer you stay, the more vacation you’ll accrue! 
• Longevity Pay (Monthly payments after two years of service) 
• Build your future with our awesome retirement/pension plan! 

We take care of our employees! As a world-renowned institution, our employees’ wellbeing is important to us. We offer work/life services such as... 

• Free financial and legal counseling 
• Free mental health counseling services 
• Gym membership discounts and access to wellness programs 
• Other employee discounts including entertainment, car rentals, cell phones, etc. 
• Resources for child and elder care 
• Plus many more! 

Position Summary:

Performs complex physician billing compliance reviews as well as for Residents, APPs (ADVANCED PRACTICE PROVIDERS-PA/NPs), internal and external Coding, and Billing staff for  Emergency Medicine including our Hospitalist, Urge

Coordinates, schedules and performs coding and documentation reviews of medical/patient records to ensure provider billing practices are compliant with applicable rules and regulations. 

Serves as a knowledge resource for coding and billing auditing functions and provides direction and guidance to Compliance Coding Analysts.  Trains and educates new/existing providers as well as coding staff. Attends meetings. 

Manages EPIC PB Edits and Requests for denial appeals. Reports review results to the Revenue Cycle Manager, Manager, and/or Medical Billing Compliance. Providers coverage/support for the Clinical Billing Manager, when needed.  

Position Key Accountabilities:

1.  Responsible for coordinating, scheduling, and implementing complex physician billing compliance reviews in collaboration with the Manager, Billing Compliance.   
2.  Serves as knowledge resource in issue resolution; may provide guidance for daily activities of coding analyst staff. 
3.  Reviews documentation to establish compliance with teaching physician billing guidelines, evaluation and management documentation guidelines, and correct coding standards based on government and third party payer requirements. 
4.  Prepares and routes monthly provider review reports.   
5.  Analyzes data/reports from compliance monitoring activities to identify trends, issues and risk areas. 
6.  Identifies provider specific educational needs relative to professional coding and documentation; Meets with providers to provide focused educational reviews to providers to enhance compliance.  
7.  Assists Compliance Coding Analysts in ongoing educational efforts. 
8.  Responds to billing and coding questions from providers, staff and administrators.  Maintains tracking system for responses.   
9.  Serves as senior liaison between Medical School Billing Compliance and Physician Business Services Compliance Training Specialists/Physician Educators. Communicates coding issues to Physician Business Services. 
10.  Maintains effective and cooperative communication with providers, their administrative and clerical support staff and hospital medical records staff. 
11.  Assists in developing department policies and procedures. 
12.  Meets and maintains established continuing education, productivity and performance standards. 
13.  Performs other duties as assigned. 

 

Certification/Skills:

1. Certified Professional Coder (CPC) or Certified Coding Specialist Physician-based (CCS-P).
2. Effective analytical and communication skills. 
3. Extensive PC knowledge, especially in the area of word processing and spreadsheets. 

Minimum Education:

Bachelor’s degree in business, health administration, health information management or relevant work experience in lieu of education. 
 

Minimum Experience:

Five years direct experience or comparable competency in chart abstraction, ICD or CPT coding, charge documentation and charge capture resolution. Knowledge of government documentation, coding and reimbursement guidelines, PATH issues and third-party payer reimbursement practices.  Experience in academic health care auditing preferred. 

Additional Information:

• Full-Time / Exempt
• High Production - High Demand position within a dynamic department
• Must know the differences between ER Provider versus ER facility billing and coding
• Coding (Must be strong in E/M Provider coding)
  • Outpatient Evaluation & Management Coding
  • Outpatient Procedure Coding
  • Outpatient Diagnosis Coding
  • Modifiers
  • Resolve Coding Edits
  • 100% Code abstraction
• Billing
  • Professional fee, appeals, cognizant of healthcare policies
  • Knowledge of RBRVS and insurance reimbursement regulations
• Compliance
  • Pre and/or Retro Chart Audits/Reviews
  • Institutional Audits (MD Chart Audits)
  • Payor Audits
  • Fraud & Abuse - Recognize risk areas and complete follow-up
  • Conducting training for compliance
• Miscellaneous
  • Enjoys researching to resolve issues while able to prioritize and manage time accordingly
  • Independent worker, self-motivator, quick learner and thinker
  • Ability to build reports and analyze data to report out

Physical Requirements:

Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects.

Security Sensitive:

This job class may contain positions that are security sensitive and thereby subject to the provisions of Texas Education Code § 51.215

Residency Requirement:

Employees must permanently reside and work in the State of Texas.