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: Masters of Business Administration, Healthcare Administration, or related field. Working knowledge of EPIC.
Preferred Education, Experience and Skills: Masters of Business Administration, Healthcare Administration, or related field. Working knowledge of EPIC.
Required Skill/ability 5: Proficient in Microsoft Office, Outlook, medical record management software, Outlook e-mail and related software applications.
Posting Position Title: Clinical Practice Specialist 3
Required Skill/ability 3: Proven knowledge of medical insurance billing procedures, third-party reimbursement methodologies, government and commercial insurance rules and regulations and compliance requirements for physicians.
Work Week: Standard (M-F equal number of hours per day)
University Job Title: Clinical Practice Revenue Analyst-Orthopedics
Required Skill/ability 1: Well-developed interpersonal, oral and written communication skills.
Required Skill/ability 4: Demonstrated knowledge of CPT, ICD-9, ICD-10 and HCPCS codes, medical terminology, medical office/hospital systems.
Required Skill/ability 2: Proven ability to conduct comprehensive analysis and reporting of data.
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: 58487BR
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.