| Job
Code: |
7012 |
| Job
Title: |
assistant director, institutional compliance |
| Creation
Date: |
05/10/00 |
|
| Revision
Date: |
02/24/07 |
| FLSA
Status: |
Exempt |
JOB SUMMARY:
To provide authoritative compliance direction,
consultation and facilitation to UTMB Institutional (Hospital and Clinical)
Departments billing for any clinical items or services. This job is responsible
for providing direction, development and refinement of the Office of
Institutional Compliance’s (OIC) oversight of the institution’s billing
operations for both physician and mid-level provider services and hospital and
hospital-based clinical services. The position also provides direction related
to coding, billing, and reimbursement policy to OIC staff.
ESSENTIAL JOB FUNCTIONS:
-
Develops and implements an institution-wide
program to prevent and detect improper billing and coding through out UTMB’s
clinical billing operation. Develops annual monitoring plans and creates
billing review programs which are performed by the ICO coding staff.
-
Develops and maintains institution-wide
coding and billing standards under which both the professional services and
hospital billing monitoring programs operate and gains consensus. Ensures
adherence to federal, state, local and university regulations and guidelines
governing compliance monitoring. Sells ideas and obtains acceptance and
action on issues resulting from compliance monitoring.
-
Maintains and fosters a fund of knowledge
regarding federal, state and local compliance guidance, initiatives, work
plans and payer regulations. Communicates and provides this information to
the compliance, provider and billing staffs in a timely manner. Keeps
abreast of new regulations and reimbursement methodologies and develops
implementation plans and strategies to address changes and new initiatives
in federal and state laws and regulations or reimbursement methodologies
that arise. Ensures that compliance monitoring standards are updated
appropriately to reflect regulatory changes.
-
Develops and manages the Compliance
Clinical Billing and Coding Office annual risk assessment. This is designed
to support and the supplement the OIC annual risk assessment, but is focused
on issues solely related to billing and coding risks from an
institution-wide perspective.
-
Independently responds to questions
regarding billing and coding issues and develops formal determinations and
positions for the Institution. These formal determinations are maintained
written accounts which are filed and become a separate group of policy
related documentation on billing and coding issues.
-
Investigates allegations of non-compliance
regarding all clinical billing activities on a institution-wide basis that
arise from anonymous reports, internal controls, self-monitoring and/or
internal education relating to professional services and hospital coding and
billing. Independently develops plans/options to address any non-compliance
issues that arise. These options include sampling methodology,
investigative procedures, and methodologies for refunding overpayments and
opportunities for remediation.
-
Independently analyzes data/reports from
compliance monitoring activities and computer program reports to identify
trends, issues and risk areas. Prepares and presents reports summarizing
compliance monitoring activities. Works closely with Compliance Training
and Education to develop and present timely and pertinent focused feedback
and education to faculty, residents, non-physician providers and staff, as
necessary.
-
Serves as the liaison for the OIC and
establishes and maintains excellent interdepartmental relationships with
clinical and business administration department heads to facilitate
cooperation and compliance regarding clinical billing. Communicates the
official policies and interpretations of the Office of Institutional
Compliance to billing and reimbursement personnel, departmental billing
managers, administrators, department chairmen and hospital administration.
-
Establishes relationships with high level
personnel of critical agencies affecting UTMB reimbursement including but
not limited to Trailblazers, the Medicare intermediary and carrier for UTMB,
state Medicaid program, the Texas Medical Foundation and other compliance
officers and compliance personnel across the country.
MARGINAL OR PERIODIC JOB FUNCTIONS:
-
Adheres to internal controls established
for the department
-
Provides training to physicians.
-
Completes other job-related functions and
special projects as assigned by the Institutional Compliance Officer.
REQUIRED EDUCATION / EXPERIENCE:
Bachelor’s degree and 6 years related experience.
Requires CPC certification and CCS certification.
EQUIPMENT:
Standard office equipment.
WORKING ENVIRONMENT/LOCATION OF POSITION:
Standard office environments.
OTHER:
Specific job requirements or physical location of some positions allocated to
this classification, may render this position security sensitive, and thereby
subject to the provisions of Section 51.215, Texas Education Code.
ANY
QUALIFICATIONS TO BE CONSIDERED AS EQUIVALENTS IN LIEU OF STATED MINIMUMS
REQUIRE THE PRIOR APPROVAL OF THE CHIEF HUMAN RESOURCES OFFICER.
THE UNIVERSITY OF TEXAS
MEDICAL BRANCH AT GALVESTON IS AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION
UNIVERSITY
