Reporting to Department Leadership, the Clinical Department Liaison will serve as the main point of contact between the clinical department and Yale Medicine (YM). Establish processes and systems in collaboration with YM to ensure that billing codes and documentation meet national standards. Monitor and enforce compliance with all relevant policies, procedures, and regulations. Develop reporting mechanisms and proactively analyze data to identify, recommend, and execute opportunities for improved revenue capture. 1. Ensure regular review of all billing activity of specific clinical sections, bill areas, physician, etc. Provide comprehensive, detailed summary of findings, including payment history, rejection analysis and frequency and status of unpaid claims. Provide advice on operational improvements to enhance efficiency of payment and overall reimbursement of clinical services. 2. Assess and institute billing workflows that may affect charge capture or result in denials. Collaborate with Central YM regarding changes. 3. Review preference list/charge capture information on a regular basis and institute changes needed between the providers and the Epic PB Analysts. 4. Develop and provide timely and accurate reports and dashboards in response to ad hoc requests from department leadership. Perform analysis to monitor performance, identify trends and areas of concern. Make recommendations to department leadership based on analysis and execute any necessary changes. 5. Develop and provide reports for comparing department providers against national metrics (billing codes and RVU). Analyze for variances. Develop and execute plan to address variances. 6. Responsible for identifying and notifying YM of any new/experimental procedures that will be performed in their department. This includes coding, pricing and wRVU assignment with expected reimbursement. Provide clinical evidence to support desired RVU values for new or unlisted services. 7. Identify need for the creation of new bill areas and institute process for develop of new bill areas with the EPIC team, YM and department finance for appropriate charge linkage and revenue mapping. 8. Collaborate with YM representatives to review and discuss findings specific to standard reports, coding, payers, EPIC workflow, focused reviews, etc. 9. Work closely with YM, faculty and/or management to obtain any departmental response needed to comply with carrier policy changes. 10. Notify the YM Credentialing Team and YM Coding & Billing Manager of any new hire/physician/APP/fellow by working effectively with the faculty affairs coordinator to ensure a New Hire Form and the UCA application and obtaining any required signatures in a timely fashion. Notify YM Credentialing and YM Central Billing Office of new provider start dates, anticipated services, Billing Department, Billing Areas, Revenue Departments, etc. 11. Collaborate with credentialing coordinator to ensure that providers have completed all required training. 12. Function as a resource and educator for department faculty and staff with respect to billing matters. Work in collaboration with YM Training to ensure all new faculty and staff are trained appropriately and in a timely fashion to bill for services. 13. Collaborate with YM to identify and rectify complaints that are due to operational or clinical concerns. 14. Perform charts audits to ensure documentation and coding is consistent with national standards. Analyze for variances. Develop plan for provider training and execute training in collaboration with YM Compliance office.
Posting Position Title: Business Analyst 1
University Job Title: Clinical Department Liaison
Work Week: Standard (M-F equal number of hours per day)
Required Skill/ability 1: Superior interpersonal, oral and written communication skills. High degree of interpersonal ability to communicate with various levels of employees within the organization. Demonstrated problem-solving ability using excellent investigative techniques to arrive at resolution.
Required Skill/ability 2: Exceptional organizational and analytical skills, with high attention to detail. Proven ability to conduct comprehensive analysis of data with complex reporting of results.
Required Skill/ability 3: Demonstrated technical knowledge of medical insurance billing procedures with third-party reimbursement methods. Working knowledge of government and commercial insurance rules/regulations. Demonstrated knowledge of CPT, ICD-9, ICD-10 and HCPCS codes, medical terminology and documentation/compliance requirements for physicians in an academic medical setting.
Required Skill/ability 4: Excellent working knowledge of medical office/hospital systems, EMR (EPIC preferred), Outlook e-mail and related software applications. Working knowledge of HIPAA regulations and impacts on practice operations. Ability to work independently with minimal supervision, as well as part of a cross-functional team to achieve common goals. Ability to lead team projects.
Required Skill/ability 5: Demonstrates a high level of integrity and innovative thinking and actively contributes to the success of the organization. Ability to work in a stressful environment, handle multiple tasks, and meet timely deadlines. Ability to prioritize and follow through. Demonstration of progressively responsible growth in the field with current role in professional capacity.
Preferred Education, Experience and Skills: Bachelor's Degree and five years of related work experience or an equivalent combination of education and experience.
Required Licenses Or Certifications:
Bachelor's Degree in a related field and four years of related experience or equivalent combination of education and experience.
Yale University is an American private Ivy League research university located in New Haven, Connecticut. Founded in 1701 in the Colony of Connecticut, the university is the third-oldest institution of higher education in the United States.