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.
Required Skill/ability 5: Well-developed interpersonal and oral and written communication skills demonstrating a high degree of professionalism, diplomacy and accountability.
Posting Position Title: Clinical Practice Specialist 3
Required Skill/ability 3: Well-developed problem-solving skills with the ability to compile, interpret and provide comprehensive analysis of data and develop clear conclusions and summarize findings.
Work Week: Standard (M-F equal number of hours per day)
University Job Title: Coding and Billing Analyst
Required Skill/ability 1: Working knowledge of CPT, ICD-10 and HCPCS codes, medical terminology, medical insurance billing procedures, third-party reimbursement methodologies, documentation/compliance requirements for physicians, HIPAA regulations and government and commercial insurance rules and regulations pertaining to correct coding initiatives.
Required Skill/ability 4: Ability to work independently and as part of a team prioritizing work with minimal supervision to achieve deadlines and common goals.
Required Skill/ability 2: Familiarity with medical office/hospital systems, medical record management software, Outlook and Microsoft Office applications and business intelligence reporting tools.
Bachelor's Degree in Health Care Administration or RN and five years of related work experience or an 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.