Job Abstract

Under the general direction of the Compliance Officer, develop, implement and coordinate medical billing auditing policies and procedures for clinical care services for Yale Medicine Administration (YMA). Evaluate school-wide billing practices, develop and implement effective training for physicians and staff on CMS regulations, changes in contracts affecting billing procedures; and develop communication vehicles for ensuring consistent and accurate billing for clinical care. This opportunity is currently remote (work from home, in or outside CT) for a position located in CT.

Essential Duties of Position: Conduct and manage completion of audits of departmental compliance chart reviews, provide guidance and training in assuring quality assurance in billing practices. Conduct school-wide quality assurance audits, review departmental activity, assess compliance among departments and direct training efforts across all clinical departments. Develop and implement training sessions for physicians and administrative staff on issues of compliance in all billing related matters. Develop training groups for continuous flow of accurate and consistent information on regulatory changes, trends in auditing and compliance. Provide leadership in designing centralized billing practices and procedures to ensure efficient and accurate billing. With the Director of Compliance, implement the School of Medicine's compliance program. Develop working manuals on compliance and billing procedures, and ensure their distribution to all users. Respond to government/agency demands for audits throughout the School of Medicine. Work with departmental administrators and chairs to formulate departmental responses and compliance with outside auditors. Gather and present school-wide information for agency required reporting. Remain informed and educate other auditors and administrative staff on up-to-date coding and auditing practices and regulatory changes. Serve as major authoritative source of information and guidelines necessary for compliant and effective billing practices.
Comprehensive knowledge of ICD-9 and CPT-4 coding and billing practices including research billing guidelines. Ability to interpret operative and procedural reports Evaluation and Management documentation guidelines. Thorough knowledge of Medicaid and Medicare billing. Experience developing auditing and quality assurance methods in large clinical practices. 1. Evaluates the effectiveness of operational procedures and makes immediate changes to facilitate the highest level of patient service and efficiency. Identifies issues that impede delivery of quality patient care; develops and implements short-term improvements and plans for long term process improvements. Partners with members of the leadership team to develop long term objectives for the practice related to productivity, compliance, communication and patient satisfaction. 2. Monitors and analyzes monthly productivity statistics and key financial indicators to assess accuracy and effectiveness of processes, and identifies trends or items requiring immediate corrective action. Reviews physician productivity and billing data regularly. Provides comprehensive detailed summary of findings to faculty including approaches to enhance efficiencies and overall reimbursement of clinical services. 3. Monitors and enforces compliance with YMA Policies and Procedures, Practice Standards, HIPAA regulations and Billing Compliance standards throughout all operational activities. Develops budgetary forecasts and profit and loss statements for the practice. Oversees the monitoring and enforcing of customer service standards for staff members addressing deficiencies. Resolves complicated billing, collections, and patient service issues by interfacing with YNHH, YMA management, faculty and other clinical Practice managers. Interfaces with YNHH and YMA Group-Patient Financial Services regarding clinician credentialing. 4. Oversees clinical practice operations of section by ensuring appropriate training, ongoing education, and monitoring of day-to-day activities. Works with the clinical leadership and other key departmental clinical/administrative staff on matters relating to practice performance and clinical issues in accordance with budget, goals and benchmarks. Provides leadership and direction to clinical staff where appropriate. 5. Researches and develops proposals for internal and external program initiatives and new clinical opportunities and advises leadership on the financial impact of new projects or initiatives. Prepares special analyses, reports and complex financial modeling to support the decision-making process. Negotiates contracts for consulting, physician leasing, affiliated hospital agreements and all other clinical agreements and managed care contracts. Analyzes proposals and determines cost, benefits, risks and liabilities. 6. Manages implementation of electronic medical record within the Practice. Streamlines communications between EMR team, physicians, and clinical staff. Establishes, implements and monitors medical record protocols and procedures. Ensures office compliance with Federal/state/local regulations. 7. Develops multifaceted communications via print, web and video to optimize and support the section’s mission to provide compassionate, state-of-the-art medical care for enhanced patient outcomes. Monitors patient satisfaction through surveys and other feedback plan responses to improve performance based on section specific goals. Recognizing the key drivers for marketing and communicating the mission and goals of the practice, develops and organizes initiatives for enhancing physician relations, customer satisfaction, community involvement, advertising and public relations. Ensures that all media is in compliance with guidelines established by University & YMA and that faculty/staff are aware of and abide by policies. 8. Establishes and monitors clinician work schedule assignments for best utilization of space and maximum productivity. Represents department with regard to facility concerns, maintenance and security. 9. Keeps current in practice management and process improvement concepts through involvement in professional organizations, seminar attendance, user group meetings and individual research. Bachelor's degree in relevant technical field and six years of related technical experience; or an equivalent combination of education and experience.