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DRG/Facility Coding Auditor (Facility Coding, Billing & Reimbursement Compliance Auditor) Job

UTMB Health

Date: Apr 9, 2014

Location: Galveston, TX, US

Job Title: DRG/Facility Coding Auditor (Facility Coding, Billing & Reimbursement Compliance Auditor)
Job ID: 31336
Location: Galveston
Business Unit: PRESD
Full/Part Time: Full-Time (40 hours)
Regular/Temporary: Regular



Min Qualifications

Bachelor's degree or equivalent and four years related experience. RHIA/RHIT or CCS certification.

Job Description:

Utilize advanced skills necessary to audit documentation, coding, and reimbursement of hospital inpatient and outpatient billing. Ensure clinical documentation reflects the level of service, severity of illness, risk of mortality, and that documentation is complete and accurate. Audits will determine if billed services are consistent with medical record documentation, and in accordance with the appropriate third party billing regulations and/or standards. Assist with the development and implementation of pre and post audit education as needed.

Salary Range

Salary range is from $49,040 - $73,560 Annually
This position is a Band Code: CS21.

Specific Job Related Duties

- Utilizes auditing software to select and conduct random audits of hospital/facility billing based on determined criteria.
- Conducts prospective and retrospective inpatient and outpatient documentation audits to confirm compliance with documentation and billing rules and regulations set forth by the Centers for Medicare and Medicaid Services (CMS), Medicare carrier and Fiscal Intermediary, State regulations and Institutional policies.
- Applies knowledge of inpatient and outpatient coding guidelines and clinical documentation requirements to review billed services.
- Maintains a thorough understanding of CPT, ICD-9-CM, and HCPCS coding principles, governmental regulations, and third party guidelines regarding documentation and/or billing compliance.
- Develops and maintains a close working relationship with Billing Compliance team to assure documentation issues, patterns, and/or trends are identified and addressed by prospective compliance education in a timely manner.
- Reviews providers' and coding personnel's coding accuracy and determines if the medical record is properly documented.
- Assists with analysis of data/reports from compliance monitoring activities to help identify trends, issues, risk areas, and opportunities for education and/or process improvement.
- Prepares and presents reports as needed.
- Monitors compliance with documentation standards and keeps current with changes in coding guidelines, compliance, reimbursement, and other regulatory updates; researches, investigates, evaluates and identifies opportunities for improvement.
- Has a good understanding of all clinical information systems and data flow across the continuum of care.
- Completes other job-related functions and special projects as assigned by Director.
- Adheres to internal controls and reporting structure.
- Standard office and patient care environments. May be required to work varying hours to accommodate feedback to physicians or other special projects.
- Performs related duties as required.

Closing Statement

Specific job requirements or physical Business Unit of some positions allocated to this classification, may render this position security sensitive, and thereby subject to the provisions of Section 51.215, Texas Education Code.

Closing Statement

Flexible work schedule with possibility of some telecommuting.

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, national origin, sex, age, religion, disability, sexual orientation, gender identity or expression, genetic information or veteran status. As a VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.


Nearest Major Market: Galveston
Nearest Secondary Market: Houston
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