Clinical Practice Specialist 3, Specialty Liaison

The successful candidate for this position will become a subject matter expert in all areas relating to revenue cycle management with a specific focus on providing ongoing analysis of the health of the revenue cycle for Yale Medicine and assigned clinical specialties with the goal of improving billings and colletions and resolving coding, billing and payer/contracting issues that may be impacting the revenue cycle.

Required Skills and Abilities

1. Ability to analyze and interpret detailed reports, develop clear conclusions and summarize findings; ability to perform quality assurance on individual accounts, monitor and analyze clinical department and payor key performance indicators and metrics for revenue cycle.
2. Ability to work effectively as a team member; demonstrated team-building skills and ability to develop good working relationships with co-workers and Yale Medicine clinical departments.
3. Ability to work, plan, research, and conduct projects independently with minimal supervision.
4. Ability to organize and prioritize workload to manage multiple tasks and meet deadlines; excellent attendance and reliability.
5. Excellent written and oral communication skills with demonstrated interpersonal ability to facilitate a team based approach.

Preferred Skills and Abilities

Comprehensive knowledge of ICD-10, CPT-4 and HCPCS coding, medical terminology and third party reimbursement policies. Proficiency with MS Word, Excel and PowerPoint. Proficiency with Epic Practice Management System and EMR. CPC certification, work related experience in a private or academic setting.

Principal Responsibilities

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.

Required Education and Experience

Bachelor’s Degree in Health Care Administration or RN and four years of related work experience or an equivalent combination of education and experience.