Summary

Responsible for conducting activities related to the development, communication, oversight, and monitoring of healthcare compliance programs within the College. This position is eligible to work hybrid within the Greater Houston, TX area with occasional onsite as needed.

Job Duties

• Analyzes billing provider documentation for completeness and compliance with governmental rules and regulations.
• Identifies trends, gaps, and areas of improvement for each reviewed provider and summarizes by department.  
• Coordinates corrective action with individual providers and assists coordinating training with the Education Manager.
• Develops audit routines in high-risk areas such as telehealth including evolving guidelines, government policy, and College policy.
• Responsible for performing daily documentation and coding audits to ensure correct compliance billing requirements are being followed by physicians, residents, and Advanced Practice Providers.
• Responds to billing compliance questions from providers of multiple specialties and entities for the entire breadth of Baylor clinical operations.
• Assists in preparing and providing summary audit results to the chairs of departments and individual faculty members.
• Analyzes chart documentation to perform compliance, billing and coding audits to ensure compliance and accuracy standards are being met.
• Performs record reviews to clarify missing, incomplete, or conflicting documentation to ensure accurate diagnosis and procedure code assignment as well as appropriate documentation.
• Attends related training and conferences and keeps abreast of any regulatory changes, policies, or procedures.
• Provides guidance and training for other team members.
• Performs other job-related duties as assigned. 

Minimum Qualifications

• Bachelor's degree. Four years of relevant experience may substitute for degree requirement.
• Four years of relevant experience.

Department-Specific Requirements

• Professional Coder Certification (AAPC, AHIMA).

Preferred Qualifications

• Certified Professional Medical Auditor Certification (CPMA).
• Advanced experience in Epic EHR.