Compliance Auditor

Compliance Auditor

Remote

Off Campus within Connecticut

Full time

136562WD

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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 required.

If the candidate does not currently hold a CPC certification, it is expected to be obtained within 6 months to 1 year after hire.

Required Skills and Abilities

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

Preferred Skills and Abilities

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

Principal Responsibilities

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

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

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

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

5.  Participate in the implementation of corrective action changes.  

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

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

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

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

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

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

12. 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.

Job Category Professional

Bargaining Unit NON

Compensation Grade Administration & Operations

Compensation Grade Profile Manager; Program Leader (24)

Salary Range $68,000.00 - $120,500.00

Time Type Full time

Duration Type Staff

Work Model Remote

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.

Health Requirements

Certain positions have associated health requirements based on specific job responsibilities. These may include vaccinations, tests, or examinations, as required by law, regulation, or university policy.

Posting Disclaimer

Salary offers are determined by a candidate’s qualifications, experience, skills, and education in relation to the position requirements, along with the role’s grade profile and current internal and external market conditions.

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 position. Employees will be assigned specific job-related duties through  their hiring department.