Revenue Integrity Compliance Coordinator

Revenue Integrity Compliance Coordinator Full Time
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 #1 hospital in Dallas-Fort Worth for the sixth consecutive year, we invite you to continue your healthcare career with us at William P. Clements Jr. University Hospital. You'll discover a culture of teamwork, professionalism, and consistent opportunities for learning and advancement into leadership roles. Job Summary The Revenue Integrity Compliance Coordinator maintains the integrity of the Revenue Integrity program to ensure compliance with Medicare/Medicaid regulations, Managed Care contractual agreements and the applicable policies of UT Southwestern University Hospital.
Experience and Education

• Graduate of an accredited nursing program, with a current license to practice in the state of Texas.
• 10 years of clinical experience as a Registered Nurse, including at least 5 to 7 years performing utilization review, charge audit, case management, CDI (Clinical Documentation Integrity) and denial/appeal functions in an acute care hospital.
• Principles of Managed Care, Medicare/Medicaid reimbursement required.
• General good health and stress coping ability. Full mobility and ability to participate in vigorous activity. Ability to speak and hear, to allow discussions with physicians, patients and other members of the healthcare team. Possess near vision acuity for accurate reading of computer screens and recording on patient charts.

Job Duties

• Monitors, tracks and coordinates all preparations for, and periodically, conduct audits requested by governmental and managed care payers, comparing clinical documentation to charges billed to identify any possible under/over charges; documents and sends audit results to payer organizations or external auditors for review and resolution as applicable; maintains communication with auditors and other relevant individual/organizations until all discrepancies are resolved.
• Develops and maintains all metrics for internally defined audits to identify under/over charges. Reports documented audit findings to appropriate departments. Performs charge audits as requested by patients; reviews billed charges for patients who are disputing charges by comparing the charges against all necessary clinical documentation and looking for discrepancies; documents audit results; posts corrections to accounts; communicates back to appropriate departments and sends to PFS/Customer Service for rebilling if necessary. Provides follow up to Compliance when appropriate.
• Performs monthly Quality Assurance checks to ensure account corrections are being performed within compliance guidelines and presents results to manager.
• Develop an overall approach for education to the various departments by directing periodic comprehensive reviews of charge capture practices. Works with various staff and departments such as Compliance, Health Information Management, clinical nursing units, physicians and others to obtain the information necessary to perform account audits.
• Assists departments with the charge reconciliation process. Works with all relevant hospital departments to provide timely education on how to correct or improve processes that have been found to be deficient. Enlists assistance from Compliance Department when necessary to ensure Administrative Policies are being followed.
• Works with various staff and departments such as Health Information Management, clinical nursing units, physicians and others to obtain the information necessary to perform account audits.
• Work with CDI and Care Coordination to improve physician documentation and assist with discharge planning gaps. Performs other duties as assigned

Knowledge, Skills and Abilities

• Complete monthly QA checks utilizing EPIC User Productivity reports and provide results to manager.
• Ensure staff is prepared to conduct periodic defense audits
• Coordinate efforts with team to ensure consistent service line charge reconciliation audits are completed and documented.
• Provide process flow and clinical guidance across the revenue cycle.

To learn more about the benefits UT Southwestern offers, visit https://www.utsouthwestern.edu/employees/hr-resources/
This position is security-sensitive and subject to Texas Education Code • 51.215, which authorizes UT Southwestern to obtain criminal history record information. UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status. To learn more, please visit: https://jobs.utsouthwestern.edu/why-work-here/diversity-inclusion