Clinical Affairs – YMA Compliance
University Job Title
Compliance Specialist III
Bargaining Unit
None – Not included in the union (Yale Union Group)
Time Type
Full time
Duration Type
Regular
Compensation Grade
Administration & Operations
Compensation Grade Profile
Senior Manager; Senior Program Leader (25)
Wage Ranges
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Work Location
Central Campus
Worksite Address
50 Division Street New Haven, CT 06511
Work Week
Standard (M-F equal number of hours per day)
Searchable Job Family
Administration, Clinical
Total # of hours to be worked:
37.5
Position Focus:
1. Under the direction of the Senior Director of Compliance, the position performs and assists in coordinating new provider education and auditing of services provided to or by Yale Medicine. Provides recommendations to improve documentation or billing systems and to correct any discrepancies discovered during audits to prevent reoccurrence of such discrepancies and to promote ethical practices consistent with the Compliance Program. 2. Role will perform comprehensive new provider compliance audits. Maintains documentation of methods used and individuals involved in verifying compliance; documented identified issues, corrective actions taken, and improvements implemented. Establishes and implements best practices for audit working paper documentation. 3. Schedules meetings with appropriate department leaders to discuss New Provider audit results. Consults with senior management and staff upon the conclusion of audits, both orally and in writing, to describe observations and recommend corrective action which will enhance compliance. 4. Assists in the development of the audit scope and objectives. Creates final audit reports for review and approval by the Senior Director of Compliance. 5. Assists in the development of policies and procedures for New Provider education and auditing process. 6. Maintains a regular schedule of auditing activities, involving department directors and clinical staff as needed to attain effectiveness of the overall Compliance Program. 7. Oversees focused education for new providers to promote knowledge regarding medical record documentation guidelines, billing rules and related standards. 8. Demonstrates a knowledge and understanding of organizational policies and procedures, billing and reimbursement requirements and other regulations that affect operations. Maintains a library of appropriate reference material that will facilitate the understanding and compliance of federal coding/documentation requirements. 9. Participates in outside healthcare compliance organizations to stay abreast of corporate compliance developments and best practices within the industry. Provides research and advice for billing compliance initiatives. 10. Ensures confidentiality of all audits and reports generated by this department, working within established policies for protection of data.
Essential Duties
1. Manages and monitors technology needs, conducts inventory, and system requirements for the assigned departments. 2. Manages and coordinates training sessions for assigned departments when new policies or practices are adopted. 3. Ensures compliance with University and federal regulations as they apply to the assigned departments. 4. Identifies and assists with the development of administrative policies for the assigned departments. 5. May perform other duties as assigned.
Required Education and Experience
Bachelors Degree in related field and 5 years of experience or an equivalent combination of education and related experience.
Required Skill/Ability 1:
Understanding of anatomy, terminology, and physiology with demonstrated experience in provider coding with CPT and ICD-9/ICD-10.
Required Skill/Ability 2:
Knowledge of health care management in terms of financial and billing concepts. Extensive knowledge of Medicare billing guidelines required.
Required Skill/Ability 3:
Knowledge of health care reimbursement and managed care issues.
Required Skill/Ability 4:
Must be proficient in Microsoft Word, and Excel. EPIC, MD Audit and ComplyTrack Experience preferred.
Required Skill/Ability 5:
Demonstrated ability to develop and conduct training.
Preferred Education, Experience and Skills:
CPC Licensure is Required
Required Licenses or Certifications
CPC license required, or the ability to receive the license within the first 90 days of employment.
Drug Screen
No
Health Screening
No
Background Check Requirements
All candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements. All offers are contingent upon the successful completion of the background check. For additional information on the background check requirements and process visit “Learn about background checks” under the Applicant Support Resources section of Careers on the It’s Your Yale website.
COVID-19 Vaccine Requirement
Thank you for your interest in employment at Yale University. Please also note that the university has a COVID-19 vaccination and booster requirement for all students, staff & faculty which is described in the COVID-19 Vaccine Program. As you search our open positions, you will see that all postings list their on-site addresses which gives more detail on the on-campus work location of the role.
Posting Disclaimer
The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and should not be construed as a declaration of specific duties and responsibilities of the particular position. Employees will be assigned specific job-related duties through their hiring departments.
EEO Statement:
University policy is committed to affirmative action under law in employment of women, minority group members, individuals with disabilities, and protected veterans. Additionally, in accordance with Yale’s Policy Against Discrimination and Harassment, and as delineated by federal and Connecticut law, Yale does not discriminate in admissions, educational programs, or employment against any individual on account of that individual’s sex, sexual orientation, gender identity or expression, race, color, national or ethnic origin, religion, age, disability, status as a special disabled veteran, veteran of the Vietnam era or other covered veteran.
Inquiries concerning Yale’s Policy Against Discrimination and Harassment may be referred to the Office of Institutional Equity and Accessibility (OIEA).
W.L. Harkness Hall, 3rd Floor, Room 303
100 Wall Street, New Haven CT 06511
203-432-0849
[email protected]
Note
Yale University is a tobacco-free campus
Source: Indeed.com
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