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 1: Current CPC certification required. Knowledge of CPT, ICD-10, HCPCS codes, medical terminology, and HIPPA regulations. Experience with an electronic health record and practice application systems, electronic data entry, and web-based applications and websites. Expert proficiency with MS Word, Excel, PowerPoint, and Outlook (emails and calendars).
Required Skill/ability 2: Knowledge of medical insurance billing procedures, third-party reimbursement methodologies and documentation/compliance requirements, government and commercial insurance rules and regulations pertaining to correct coding initiatives.
Required Skill/ability 3: Well-developed problem solving skills with the ability to be innovative, ability to compile comprehensive analysis of data with complex and professional reporting of results, analyze and interpret detailed reports, develop clear conclusions and summarize findings.
Required Skill/ability 4: Ability to work independently as well as part of a cross-functional team to plan, research and conduct projects as well as manage timelines and work to achieve common goals.
Required Skill/ability 5: Well-developed interpersonal, and oral and written communication skills demonstrating a high degree of professionalism, diplomacy and accountability.
Work Week: Standard (M-F equal number of hours per day)
Posting Position Title: Clinical Practice Specialist 3
University Job Title: Coding & Billing Analyst
Bachelor's Degree in Health Care Administration or RN and four 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.