Because Department of Pediatrics providers are all cleared (with extremely rare exceptions, e.g. non-faculty contract providers) to do their own service coding under the Provider Coding Initiative, one of the key members of the Revenue Cycle Team has been our Compliance Education Consultant. The incumbent works closely with all providers and Division Chiefs on a regular basis, as well as being responsible for the training of new faculty members and their preparation for PCI clearance by Compliance Office personnel. The Department has a very diverse and complex range of sub-specialty providers which is further complicated by the fact that roughly four out of five Pedi patients are covered by Texas Medicaid, arguably the most idiosyncratic payor in the industry. With around 100 busy providers providing a wide range of services in a complex billing environment it is essential that we have a Compliance Education Consultant on the Department Revenue Cycle Team ? and one dedicated exclusively to the diverse support needs within the Department. Because of the Pedi book of business it is very desirable have a person in the position who has both Pediatric and Texas Medicaid experience.
Researching and remaining current with documentation/coding policies/guidelines with attention to Novitas requirements; remaining current with yearly ICD and CPT changes as they occur, and disseminating this information to relevant divisions within the Department; training new providers in basic documentation and billing requirements and working with the process set by the Office of Regulatory Affairs and Compliance for Provider Coding Initiative clearance for independent billing; serve as a liaison with Compliance Office re clearing providers (as above) and audit findings/follow-up; code uncleared provider encounters
Assist with in-house retrospective Departmental audit cycle (with specific direction given by Revenue Cycle leadership regarding division(s) to be reviewed).
Perform prospective audits of cleared providers documentation/coding when directed by Revenue Cycle leadership; identify opportunities for optimizing coding/revenue as they occur; attend Division and/or individual provider meetings to provide education and up-dates when requested; work assigned Work Queue edits; assist collectors with coding related denial/appeals research; request/review records in Med Rec as needed.
Develop and keep all training materials current - Basic Documentation Training Slide Set and Specialty Specific Supplementary Training Slide Sets for all Divisions including instruction in any relevant procedure documentation and billing; assist with coordinating ancillary provider training (e.g. SuperBill, PatientKeeper, etc.); assist with charge capture studies to identify issues, problems with work flow processes; do any required research necessary to respond to provider documentation/coding questions. Qualifications
Bachelors degree in Business Administration, Healthcare Administration, Medical Records, or related field with five years experience in physician billing, health information administration, medical records administration, or related activities. Professional coding certification from an accredited agency is required.
Preferred Qualifications : Ability to manage the complex and extensive workload delegated to them in a timely, balanced and responsible manner with minimal supervision.
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THIS POSITION IS SECURITY SENSITIVE
AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER
UT Health Science Center San Antonio - 18 months ago