Position Focus:
Under the general direction of the Compliance Officer develops, implements and coordinates medical billing auditing policies and procedures for clinical care services billed in clinical research studies. Evaluates school-wide billing practices and multiple systems for documentation and billing, develops and implements effective training for physicians and staff on CMS regulations, changes in contracts affecting billing procedures; and develops communication vehicles for ensuring consistent and accurate billing for clinical care. Conducts and manages completion of research audits of departmental compliance chart reviews, provides guidance and training in assuring quality assurance in billing practices. Conducts school-wide quality assurance research audits, reviews departmental activity, assesses compliance among departments and direct training efforts across all clinical departments. Develops and implements training sessions for physicians and administrative staff on issues of compliance in all billing related matters. Develops training groups for continuous flow of accurate and consistent information on regulatory changes, trends in auditing and compliance. Provides leadership in designing centralized billing practices and procedures to ensure efficient and accurate billing.
Principal Responsibilities
1. Reviews and determines staffing needs, job posting requirements, salary guidelines, and labor agreement interpretations for exempt and non-exempt staff in one or more functional department of the University. 2. Manages the administrative support needs for exempt and nonexempt staff and provides recommendations, improvements, solutions and assistance as needed. 3. Manages and monitors technology needs, conducts inventory, and system requirements for the assigned departments. 4. Develops and prepares budgets, financial forecasts, and financial analyses and the actual vs. budgeted performance reports for the departments. 5. Manages the use of facilities in one or more departments including office space, work stations, equipment, and office supplies. 6. Manages administrative support for activities of one or more departments to ensure timely completion of projects. 7. Manages and coordinates training sessions for assigned departments when new policies or practices are adopted. 8. Ensures compliance with University and federal regulations as they apply to the assigned departments. 9. Identifies, plans, and develops administrative policies for the assigned departments. 10. Assists in reviewing and implements University and departmental policies as they pertain to the administrative functions of the assigned department. 11. Assesses and makes recommendations regarding staff development and staffing levels. 12. Monitors, develops, plans, and executes systematic research on user requirements through such mechanisms as surveys, interviews, focus groups and competitive analysis. 13. Manages a staff of exempt and non-exempt employees. 14. May perform other duties as assigned.
Required Education and Experience
Bachelor’s Degree in related field and 5 years of experience or an equivalent combination of education and related experience.
Required Skill/Ability 1:
Excellent written and oral communication skills with demonstrated ability to interact with faculty and staff and external entities at all levels regarding complex medical issues and regulatory/compliance information.
Required Skill/Ability 2:
Comprehensive knowledge of ICD-9 and CPT-4 coding and billing practices with significant emphasis on compliance and auditing.
Required Skill/Ability 3:
Demonstrated skills in Microsoft Word and Excel as well as electronic medical record systems (i.e., EPIC, IDX)
Required Skill/Ability 4:
Skilled in medical chart review, extensive medical terminology and auditing processes in a large multi-specialty clinical practice
Required Skill/Ability 5:
Proven and effective written and oral communication skills to provide guidance, training and regulatory review.
Preferred Education, Experience and Skills:
Experience as a practicing nurse with extensive chart review responsibilities
Preferred Licenses or Certifications:
RN license and CPC certification.
Weekend Hours Required?
No
Evening Hours Required?
No
Drug Screen
No
Health Screening
No
Background Check Requirements
All External 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. Please visit www.yale.edu/hronline/careers/screening/faqs.html for additional information on the background check requirements and process.
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.
Affirmative Action Statement:
Yale University considers applicants for employment without regard to, and does not discriminate on the basis of, an individual's sex, race, color, religion, age, disability, status as a veteran, or national or ethnic origin; nor does Yale discriminate on the basis of sexual orientation or gender identity or expression.
*Original Posting Date:* 16-May-2015
*STARS Requisition number:* 30910BR
*Department:* YSM Compliance
*University Job Title:* Manager 3
*Bargaining Unit:* None
*Job Category:* Managerial & Professional
*Position MP Overtime Eligible?:* No
*Type of Employment:* Full Time
*Duration Type:* Regular
*Salary Grade:* 25
*Work Location:* Medical School Campus
*Worksite Address:* 300 George St
*Work Week:* Standard (M-F equal number of hours per day)