YM New Provider Auditor and Educator – Yale University – New Haven, CT

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

Click here to see our Wage Ranges

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:

Reporting to the Senior Director of Compliance, the New Provider Auditor & Educator will assist in the planning, organizing, and completion of New Provider education and auditing activities required to comply with federal guidelines and other compliance-related requirements. The role will seek to collaboratively increase and strengthen new providers’ awareness and understanding of medical record documentation guidelines and coding principles. Providers who complete new provider compliance training and meet Yale Medicine’s defined audit accuracy threshold, will transition from the education and review period to coding their own services. The position serves as a role model for ethical management behavior and promotes an awareness and understanding of the Yale Medicine Compliance Program. The position will assist in assessing New Provider documentation and coding risks and develop a New Provider auditing plan to support the overall compliance program. This position may require remote work on either a regular or temporary, part-time or full-time basis.

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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