Compliance Analyst III, Hospital Billing Auditor

About the Role

UT Southwestern Medical Center is seeking a Hospital Billing Auditor to join our Office of Institutional Compliance & Audit Services. This role plays a critical part in ensuring the integrity of hospital billing and reimbursement processes at one of the nation's premier academic medical centers.

Responsibilities

• Audit hospital (facility) claims for compliance with Medicare, Medicaid, and commercial payer billing requirements.
• Evaluate documentation to ensure accurate coding, charging, and reimbursement for inpatient and outpatient hospital services.
• Identify billing trends, compliance risks, and opportunities for process improvement.
• Partner with Revenue Cycle, Patient Financial Services, Coding, Clinical Operations, and Compliance leaders to strengthen billing integrity.
• Provide education and guidance to improve hospital billing practices while reducing regulatory risk.
• Serve as team leader and project manager for complex assurance/effectiveness reviews, including establishing goals, objectives, timelines, and quality measures.
• Conduct complex assurance/effectiveness reviews of compliance activities in accordance with appropriate standards and established compliance plans.
• Evaluate the effectiveness of compliance controls and adherence to university policies and procedures.
• Prepare compliance reports, providing supporting evidence and defending findings and recommendations regarding identified deficiencies or gaps.
• Assist in investigations of alleged breaches of policy, misconduct, or other acts of non-compliance to determine cause, extent of loss, and prevention mechanisms.
• Maintain effective working relationships with compliance personnel to achieve objectives of assurance-related assignments.
• Stay abreast of current developments in compliance.
• Develop and maintain compliance-related education and training materials, and conduct training sessions as needed.
• Perform other assigned duties.

Requirements

• Bachelor's Degree in business or healthcare administration, regulatory compliance, consulting, project management, or related area.
• 5 years of professional experience in a compliance-related field.

Preferred Qualifications

• Compliance Certification.
• Experience in hospital/facility billing audits.
• Revenue integrity or revenue cycle experience.
• Knowledge of Medicare Outpatient Prospective Payment System (OPPS) and Inpatient Prospective Payment System (IPPS).
• Familiarity with UB-04 billing and facility reimbursement.
• Understanding of CMS billing regulations and payer requirements.
• Experience with hospital coding and reimbursement compliance.

Benefits

• PPO medical plan, available day one at no cost for full-time employee-only coverage.
• 100% coverage for preventive healthcare with 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.

Location

Texas-Dallas-5323 Harry Hines Blvd

Full-time, Day Shift