Compliance Auditor

Yale University; New Haven (CT); On-site; USD 60,000 - 80,000; Full time

Job summary

Yale Cancer Center seeks a Medical Billing Auditor to coordinate audits for Yale Medicine Administration. This remote position requires expertise in ICD-10 and CPT-4 coding, strong communication skills, and data analysis capabilities. A Bachelor’s degree and 5 years’ experience in a relevant field are mandatory.

Responsibilities include conducting audits, evaluating billing compliance, and training staff in accurate coding. CPC certification is required or must be obtained within the first year.

Qualifications

• 5 years’ experience in multi-specialty group practice or equivalent.
• Bachelor’s degree in Health Care Management or related.
• CPC required or must obtain within 6-12 months after hire.

Responsibilities

• Conduct audits of departmental compliance chart reviews.
• Evaluate documentation for coding accuracy and compliance.
• Design and maintain tracking logs of investigations.
• Provide training on medical billing compliance.

Skills

ICD-10 and CPT-4 coding knowledge

Communication skills

Attention to detail

Data analysis ability

Microsoft Office proficiency

Education

Bachelor's in Health Care Management or related field

5 years experience in related field

Tools

Epic

Microsoft Excel

Microsoft Access

Job description

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

• 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.
• 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 ICD-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.

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 basedon 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.

Equal Employment Opportunity Statement

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.