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Coding Compliance Manager

Company: University of North Texas Health Science Center
Location: Fort Worth
Posted on: December 6, 2019

Job Description:

Department OverviewThe University of North Texas Health Science Center Office of Institutional Compliance & Integrity is seeking to hire a Provider Audit Manager to join our team. This Provider Audit Manager position shall be primarily responsible for designing, developing, implementing, overseeing and performing internal audits and reviews for the Office of Institutional Compliance and UNT Health. Applicants will also assist UNTHSC's Correctional Medicine Department in conducting routine compliance audit review including verifying coding accuracy of medical claims for inpatient/outpatient facilities and professional physician services provided under federal correctional health care contracts.The University of North Texas System and its component institutions are committed to equal opportunity and comply with all applicable federal and state laws regarding nondiscrimination and affirmative action. The University of North Texas System and its component institutions do not discriminate on the basis of race, color, sex, sexual orientation, gender identity, gender expression, religion, national origin, age, disability, genetic information, or veteran status in its application and admission processes, educational programs and activities, and employment practices.Position DetailsThe University of North Texas Health Science Center Office of Institutional Compliance & Integrity is seeking to hire a Provider Audit Manager to join our team.Responsibilities of the position include but are not limited to:* Perform independent reviews and evaluations to ensure that compliance issues within multiple departments are being appropriately evaluated, investigated, and resolved.* Serve as resource to the Compliance Specialist and Revenue Cycle Management staff to obtain information on accurate coding and documentation standards, guidelines, and regulatory requirements.* Conduct routine audits and reviews for Correctional Medicine and UNT Health providers including coordinating and monitoring coding and documentation for accuracy. Collect, analyze, interpret, and document reports to support findings.* Review claim denials and rejections pertaining to coding and medical necessity issues. When necessary, assist in the implementation of corrective action plans, such as educational programs, to prevent similar denials and rejections.* Report noncompliance issues detected through auditing and monitoring, nature of corrective action plans, results of follow-up to the Chief Compliance Officer and/or the Deputy Compliance Officer.* Remain current on all compliance issues as related to the healthcare industry, annual coding updates, and frequent regulatory changes.* Understand and maintain strict professional confidentiality of patient information, work plans, and projects.* Maintain access to electronic resources, associations, conferences and other compliance sources to keep up to date on releases on changes in laws, rules, and regulations.* Collaborate and coordinate with staff when performing assigned duties. Including partnering with assigned departments, locations, programs, and/or service lines to address unique compliance risks and provide general compliance visibility and support.* Provide all other duties as assigned necessary to support the missions and goals of Office of Institutional Compliance, UNT Health and Correctional Medicine and provide research and support for special projects, when required.Department Specific Responsibilities:* Work with department heads to establish statistical sampling methodologies and follow up protocols for compliance audits and reviews.* Direct coding and billing departments to mitigate physician and facility coding anomalies for both internal claims processed and external claims received.* Provide individualized feedback and information to providers and facilities as it relates to the compliance audits being performed.* Monitor and follow up on providers and departments response to recommendations.* Discover preventative and corrective measures based on findings and coordinate improvement plans with appropriate department heads when necessary.* Coordinate and perform educational training programs for Correctional Medicine staff, providers, facilities and/or other appropriate personnel consisting of documentation guidelines and accurate coding practices.* Conduct annual audits as it relates to the Office of the Inspector General (OIG) and Office of the Medicaid Inspector General (OMIG) to ensure adherence with Federal and State guidelines.* Prepare audit reports to document areas under review, procedures performed and conclusions met.* Provide all departments with feedback on trends and/or other issues which could compromise contract performance and compliance with contract requirements.* Exercise professional care in performing all internal audits and compliance reviews.Required QualificationsThe successful candidate will possess the following required qualifications:* Bachelor's degree and Registered Health Information Administrator (RHIA)/Registered Health Information Technician (RHIT) and five (5) years related experience; or equivalent combination of education and experience.* Must have a minimum of five (5) years of compliance auditing experience; including extensive knowledge of ICD-9, ICD-10, CPT, APC, LTC and DRG coding principles.* Must have experience in coding for multi-specialty professional and facility services; extensive knowledge of current Medicare coding and billing guidelines and requirements; and knowledge, skills, and disciplines essential to the performance of coding compliance audits and reviews.Preferred QualificationsThe preferred candidate will possess the following additional qualifications:* Additional American Health Information Management Association (AHIMA), Certified Healthcare Compliance (CHC), and/or American Academy of Professional Coders (AAPC) certification(s) preferred.* Current Certified Professional Coder in ICD-10, ICD-9, CPT, HCPCS, modifiers, through an accredited healthcare business organization. Also extensive knowledge of APC and DRG coding and billing methodologies.Special Instructions to Applicants:Applicants must submit a resume along with a cover letter with their online application.Pay RateSalary Commensurate with ExperiencePay BasisMonthlyJob TypeFull-TimeWork ScheduleMonday - FridayApplication Types AcceptedMain FormOccupational Exposure to HIV/HBV?NoOccupational Exposure to Hazardous Chemicals?NoOccupational Exposure to Tuberculosis?NoSecurity Sensitive?YesRequire a valid Texas Driver's License?YesRequire a certification?No

Keywords: University of North Texas Health Science Center, Fort Worth , Coding Compliance Manager, Executive , Fort Worth, Texas

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