Compliance Analyst III, Hospital Billing Auditor

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 number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career! 

JOB SUMMARY
Are you an experienced Hospital Billing Auditor looking to take your career to the next level? If you have a passion for ensuring billing accuracy, navigating complex reimbursement regulations, and improving compliance across hospital services, we'd love to hear from you.

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

In this role, you will:

• 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 that helps improve hospital billing practices while reducing regulatory risk.

We're looking for professionals with experience in:

• Hospital/facility billing audits
• Revenue integrity or revenue cycle
• Medicare Outpatient Prospective Payment System (OPPS) and Inpatient Prospective Payment System (IPPS)
• UB-04 billing and facility reimbursement
• CMS billing regulations and payer requirements
• Hospital coding and reimbursement compliance

BENEFITS
UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare-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
• Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATION

Required

• Education
  Bachelor's Degree in business or healthcare administration, regulatory compliance, consulting, project management, or related area 
   

• Experience
  5 years of professional experience in a compliance-related field. 
   

Preferred

• Licenses and Certifications
  Compliance Certification 
   

JOB DUTIES

• Serves as team leader and project manager while conducting complex assurance/effectiveness reviews or other department projects, including the establishment of goals, objectives, timelines and quality measures for the team's work and deliverables.
• Conducts complex assurance/effectiveness reviews of compliance activities in accordance with appropriate standards, metrics, established compliance plan(s) and prescribed departmental/unit/program policies.
• Evaluates effectiveness of compliance controls used by reviewed department/unit/program, as well as compliance with all applicable university policies and procedures.
• Prepares compliance reports and is capable of providing supporting evidence and defend the findings and recommendations made regarding identified compliance deficiencies or gaps.
• Assists in investigations of alleged breaches of policy, misconduct or other acts of non-compliance to determine the cause, extent of loss and mechanisms for prevention.
• Maintains effective working relationships with compliance personnel to achieve objectives of assurance-related assignments.
• Remains abreast of current developments in compliance.
• Develops and maintains compliance-related education and training materials and, when necessary, conducts training sessions on compliance-related topics.
• Performs other duties, as assigned.

SECURITY AND EEO STATEMENT

Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

EEO
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.