Compliance Auditor Job New Haven Connecticut USA,Healthcare

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Salary Range

$68,000.00 - $

Overview

Coordinate and conduct medical billing audits for the Yale Medicine Administration. Evaluate medical billing, coding and documentation for 18 clinical departments under the direction of the Compliance Officer. Provide training and feedback to physicians and departmental personnel who have responsibilities with billing activities. This opportunity is currently remote (work from home, in or outside CT) for a position located in CT.

CPC or similar certification needed within 12-18 months.

Required

Skills and Abilities

Demonstrated knowledge of ICD-10 and CPT-4 coding and billing practices.
Ability to interpret operative and procedural reports.
Well-developed oral and written communication skills.
Strong attention to detail with the ability to analyze data.
Proficient in Microsoft Word, Excel, and Access.

Preferred

Skills and Abilities

CPC credentials preferred.
Computer skills including Epic, WEBI, Word, Excel, and Access.
Experience in healthcare auditing, Medicare and Medicaid, or related clinical field.
Experience in healthcare auditing, Medicare and Medicaid or related clinical experience.

Principal Responsibilities

Primary responsibility is to complete audits of departmental compliance chart reviews and to participate in audits requested by third party payors.

Assess provider documentation for ICD-10 and CPT-4 coding accuracy, compliance with University and government regulations.

Obtain and review charge documents, encounter forms, medical records and billing procedures.

Evaluate results, identify system control weaknesses and in conjunction with department management, develop plan of action and solutions based on audit results.

Participate in the implementation of corrective action changes.

Design and maintain accurate tracking logs, including spreadsheets, of all ongoing investigations.

Follow up on corrective action. Report findings to the Compliance Officer, PFS and University Auditor as needed.

Conduct training sessions with individual physicians and/or departments on medical billing compliance. Provide input on areas and subjects where education is needed.

Advise and assist in development of training materials and programs for clinical and billing staff relative to accurate coding, documentation billing and regulatory guidelines.

Conduct data analysis. Generate reports using Query tools to identify trends and problem areas for focus of internal audits.

Participate in the ongoing implementation of the Compliance Program. Knowledge of University Medical Billing Compliance Plan, operations and procedures.

Stay abreast of best practice coding and auditing practices and regulatory changes. Maintain CPC designation by obtaining necessary CEUs on an annual basis.

Required

Education and Experience

Bachelor's in Health Care Management, Finance, Business or Nursing or a related field. Five years’ experience in multi-specialty group practice, academic plan or hospital or an equivalent combination of educational and experience.

Equal Opportunity Employment

The University is committed to basing judgments concerning the admission, education, and employment of individuals upon their qualifications and abilities and seeks to attract to its faculty, staff, and student body qualified persons from a broad range of backgrounds and perspectives. In accordance with this policy 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).

Note

Yale University is a tobacco-free campus.

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