1. Regularly reviews billing activity or specific clinical departments or sections. Provides comprehensive, detailed summary of findings (payment history, rejection analysis, frequency and status of unpaid claims, etc.). Communicates and provides regular updates to administration, physicians and coders. 2. Provides advice on operational improvement to enhance efficiency of payment and overall reimbursement of clinical services. 3. Develops, implements, and monitors policies and procedures to optimize provider reimbursement. Functions as a resource and educator for clinical department physicians and all appropriate staff on billing and coding issues by department. 4. Develops training or educational programs and working manuals on procedural guidelines and implementation of new regulatory standards and initiates changes as contracts and regulations change. 5. Collaboratively establishes policies and procedures to resolve issues around claims that are rejected, nor responded to, underpaid, etc. Provides recommendations on how to reduce rejections to improve collections. 6. Researches policies of payers and communicates changes as appropriate. Maintains regular interactions and communication with third party payers. 7. Leads and/or assists with the management and/or performance of ongoing reimbursement projects, including but not limited to in depth analysis of variances and tracking/managing issues with carriers. 8. Performs coding audits, assesses risk and communicates findings. 9. Ensures compliance with University, governmental and all third party regulations, including claim submission, coding accuracy and documentation to support billing. Performs quality assurance processing and assesses degree of risk for non-compliance with internal audit findings. 10. Manages and coordinates decisions on optimizing output of subordinates and colleagues in producing information. 11. May manage staff of both exempt and non-exempt employees. 12. May perform other duties as assigned.
Preferred Education: Experience working with EPIC. Knowledge of government and commercial insurance rules and regulations pertaining to correct coding initiatives.
Preferred Education, Experience and Skills: Experience working with EPIC. Knowledge of government and commercial insurance rules and regulations pertaining to correct coding initiatives.
Required Skill/ability 5:
Well-developed problem solving, interpersonal, oral and written communication skills with the ability to maintain a high degree of professionalism, diplomacy and accountability.
Posting Position Title: Clinical Practice Specialist 3
Required Skill/ability 3: Proficiency with Outlook and Microsoft Office applications.
Work Week: Standard (M-F equal number of hours per day)
University Job Title: Coding & Billing Analyst
Required Skill/ability 1: Knowledge of medical office and/or hospital systems, medical insurance billing procedures, CPT, ICD-10, HCPCS codes, medical terminology, HIPAA regulations, third-party reimbursement methodologies and documentation/compliance requirements for providers. .
Required Skill/ability 4: Ability to plan, research and prioritize projects independently with minimal supervision as well as a member of a cross-functional team
Required Skill/ability 2: Ability to compile, analyze and interpret comprehensive analysis of data through the use of business intelligence reporting tools and medical record practice management software.
Bachelor's Degree in Health Care Administration or RN and five years of related work experience or an equivalent combination of education and experience.
Internal Number: 54798BR
About Yale University
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.