Requisition Number: 19604BR
Department: YMG Reimbursement
University Job Title: Clinical Practice Specialist 3
Posting Position Title: Reimbursement Analyst
Bargaining Unit: None
Job Category: Managerial & Professional
Type of Employment: Full Time
Duration Type: Regular
Salary Grade:
Work Week: Standard - 37.5 hrs (M-F, 8:30-5:00)
Work Location: Medical School Campus
Worksite Address: 300 George
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 five years of related work experience or an equivalent combination of education and experience.
Background Check Requirements: All external candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle and credit checks based on the position description and job requirements. All offers are contingent on successful completion of a background check. Please visit www.yale.edu/hronline/careers/screening/faqs.html [4] for additional information on the background check requirements and process.
Weekend Hours Required?: No
Evening Hours Required?: No
Drug Screen: No
Health Screening: No
Yale University is an affirmative action/equal opportunity employer. Yale values diversity in its faculty, staff, and students and strongly encourages applications from women and members of underrepresented minority groups.