Compliance Auditor

Position Focus :

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.

Essential Duties

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.

Required Skill / Ability 1 :

Demonstrated knowledge of ICD-10 and CPT-4 coding and billing practices.

Required Skill / Ability 2 :

Ability to interpret operative and procedural reports.

Required Skill / Ability 3 :

Well-developed oral and written communication skills.

Required Skill / Ability 4 :

Strong attention to detail with the ability to analyze data.

Required Skill / Ability 5 :

Proficient in Microsoft Word, Excel, and Access.

Preferred Education, Experience and Skills :

CPC credentials preferred. Computer skills include Epic, WEBI, Word, Excel, and Access. Related clinical field background.

Experience in healthcare auditing, Medicare and Medicaid or related clinical experience.

Drug Screen

Health Screening

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.

COVID-19 Vaccine Requirement

The University maintains policies pertaining to COVID-19. All faculty, staff, students, and trainees are required to comply with these policies, which may be found here :

Posting Disclaimer

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 particular position.

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