Revenue Integrity Educator III

WHY UT SOUTHWESTERN?

With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals.

Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career!

JOB SUMMARY

Revenue Cycle Management Support:
Research coding, documentation and reimbursement inquiries submitted by physicians, clinical departments, or revenue cycle management to ensure compliance with specific payer and/or government regulations and optimum reimbursement. Prepares timely responses based on research outcome. Conduct quality assurance reviews to ensure coding and billing practices are accurate, compliant with regulations, and aligned with university policies and Revenue Cycle Management guidelines. Reviews charges for any service line, ensures timely resolution, assists Supervisor with broader monitoring.

Monitors team queues regularly, ensures team-wide timely resolution, performs quality assurance reviews

New Provider

Education:

Conduct standardized education for new providers (physicians, advanced practice providers, and other professional practitioners) for Internal Medicine, Pediatrics, Emergency Medicine, Radiology, PM&, R, Neurology, Psychiatry. Perform pre-bill reviews of professional charges and follow up with new providers to ensure accurate coding and documentation practices. Performs post-onboarding pre-bill review of professional charges and follow-up with new providers to confirm understanding documentation requirements to promote billing compliance.

Independently conducts reviews, applies critical thinking, develops detailed action plans for risk mitigation. Independently develops, updates, and conducts onboarding and specialty-specific training

Clinical Department

Education:

Develop and conduct individual or group physician education presentations on coding, billing compliance guidelines, audit findings or internal reporting. Develop comprehensive content for presentations, including key concepts, regulations, case studies and practical examples.

Billing Compliance Reviews:
Conduct independent reviews on adequacy of medical record documentation to support the procedure, modifier and diagnosis coding of any service line billed by any supported physicians, practitioners or billing staff, or areas that may pose a compliance risk and develop recommended solutions/action plans, which may include revised workflows and/or education. Serves as a professional billing integrity project leader, for all service lines, under minimal supervision.

Leads project independently with minimal supervision.

* Shift: Monday through Friday, 8am-5pm. Additional details shall be discussed as part of the interview process.

* Work From Home (WFH):
This is a WFH opportunity. Candidates must live in Texas. Additional details shall be discussed as part of the interview process.

BENEFITS

UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

* PPO medical plan, available day one at no cost for full-time employee-only coverage

* 100% coverage for preventive healthcare-no copay

* Paid Time Off, available day one

* Retirement Programs through the Teacher Retirement System of Texas (TRS)

* Paid Parental Leave Benefit

* Wellness programs

* Tuition Reimbursement

* Public Service Loan Forgiveness (PSLF) Qualified Employer

* Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATION

Required

* Education

High School Diploma or equivalent

* Experience

6 years of experience in a professional billing environment with emphasis on coding, auditing and/or compliance responsibilities

* Licenses and Certifications

(CPC) CERT PROFESSIONAL CODER Upon Hire or

(CCS) CERT CODING SPECIALIST Upon Hire or

(CMC) CERT MEDICAL CODER Upon Hire or

(CPMA) Cert Prof Medical Auditor within 1 Year

Preferred

* Education

Bachelor's Degree

* Licenses and Certifications

(RN) REGISTERED NURSE Upon Hire

JOB DUTIES

* Serves as a professional billing integrity project leader, for all service lines, under minimal supervision, to develop and conduct individual or group presentations on coding, billing and compliance topics, based on new regulatory and/or professional coding industry information; pre-bill professional charge review findings;
University-identified risk areas, or special projects requested by MSRDP leadership. This may include medical record audits,…