Prof Rev Compliance Aud/Educator

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Jun 12, 2020


Job Description


To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

The primary focus of the position is to provide education and conduct audits for the physicians and their staff. Assists in the planning, organizing, and completion of auditing activities required to comply with federal payors and other compliance-related requirements. To identify lost revenue opportunities and any overpayments made due to errors in coding, insufficient medical record documentation, etc. To increase and strengthen health care providers' awareness and understanding of medical record documentation guidelines and coding principles. Serves as a role model for ethical management behavior and promotes an awareness and understanding of the System's Code of Conduct and Privacy and Corporate Compliance Program. Assists the Manager, NEMG Revenue Integrity in assessing risk and developing an audit and education plan to support the overall compliance plan. Interacts with all levels of management within the Health System.



1.Under the direction of the Manager, NEMG Revenue Integrity, assists in the performance of risk
analysis to identify areas with greatest potential for non-compliance with governmental and internal

2. Performs and assists in coordinating revenue integrity auditing of services provided to or by NEMG.
Provides recommendations to improve documentation or billing systems and to correct any
discrepancies discovered during audits to prevent reoccurrence of such discrepancies and to promote
ethical practices consistent with the Compliance Program.


3. Assists the NEMG Revenue Integrity Audit Manager in developing and implementing a compliance
education program for the physicians, their staff and the NEMG leadership and staff. Conducts
education sessions both one on one and via group settings. Evaluates the effectiveness of education
sessions and makes recommendations for improvement.


4. Works with physician department management to implement compliance education and to perform
comprehensive compliance audits as designed and directed via the Annual Compliance Work Plan .
Maintains documentation of methods used and individuals involved in verifying compliance; documented
identified issues, corrective actions taken, and improvements implemented. Establishes and
implements best practices for audit working paper documentation, security, and retention.


5. Works with external auditors, hired as independent contractors, to coordinate access to audit data and
to finalize audit finding reports.


6. Assists in the development of policies and procedures for auditing medical records for compliance with
required documentation guidelines including completeness and accuracy of coding. Makes
recommendations which are consistent with regulatory requirements for coding/ documentation, to
assure that services rendered are documented and bills are submitted appropriately as an integral part
of Yale New Haven Health System's overall Compliance Program.

7. Maintains a regular schedule of auditing activities, involving department chiefs, NEMG leadership and
other staff as needed to attain effectiveness of the overall Compliance Program .


8. Oversees focused, technical education for physicians and other staff to promote knowledge regarding
medical record documentation guidelines, billing rules and related standards.


9. Regularly assists in the development and presentation of programs to staff to accomplish educational
objectives as set forth in the Compliance Program.


10. Supports Yale New Haven Health System's efforts towards appropriate billing processes in compliance
with federal regulations by working closely with financial, information systems, and billing staff.


11. Supports Yale New Haven Health System's efforts towards establishing appropriate guidelines for
compliance with third party requirements.


12. Participates in charge master reviews and other coding reviews, coordinating follow up.


13. Assists in the retrieval of data to assist department directors/managers in accomplishing the objectives
of compliance, as may be necessary.


14. Demonstrates a knowledge and understanding of organizational policies and procedures, billing and
reimbursement requirements and other regulations that affect operations . Maintains a library of
appropriate reference material that will facilitate the understanding and compliance of federal
coding/documentation requirements.


15. Participates in outside healthcare compliance organizations to stay abreast of corporate compliance
developments and best practices within the industry. Provides research and advice for billing
compliance initiatives.

16. Ensures confidentiality of all audits and reports generated by this department, working within
established policies for protection of data.


17. As requested, attends System and/or Delivery Network Privacy and Corporate Compliance Committee
meetings to discuss risk assessment or auditing processes and results. Collaborates with the
Manager, System Revenue Integrity and/or the Delivery Network Compliance & Privacy Officers to
prepare meeting materials.

18. Works collaboratively with the Yale Medical Group Compliance Office in performing risk assessments ,
developing audit programs, and completion of audits.

19. Performs in a professional manner, exercising independent judgment and ethical standards.


20. Interacts with employees at all levels, demonstrating impartiality and fairness at all times.


21. Supports the Compliance Officers in activities which further the goals of Yale New Haven Health System
and the Compliance Program.

22. Represents the Office of Privacy & Corporate Compliance through participation in various system
committees and work groups, including billing and research compliance, revenue cycle management,
denials, and others as assigned.

23. Actively participates in routine departmental and team meetings within the Office of Privacy and
Corporate Compliance.

24.Strives to continually improve the compliance program.


25. In conjunction with the Manager, System Revenue Integrity, develops personal and departmental goals
and objectives consistent with those of the Health System.

Secondary Functions


2 .1 Attends meetings and serves on committees.


2.2 Enhances professional growth and development through in-service meetings, education programs,
conferences, etc.

2 .3 Complies with policies and procedures as they relate to the position. Maintains confidentiality in all

2 .4 Performs similar or related duties as assigned or directed.




Certified Professional Coder required. Associate's Degree in Accounting, Business Administration or Healthcare Administration preferred.




Minimum of five (5) years experience in a healthcare setting with experience performing medical record audits for clinical documentation, charge and reimbursement accuracy. Demonstrated training and presentation skills. Minimum 3 years E&M coding experience. Experience in hospital and provider coding with CPT and ICD-9-CM. Knowledge of health care management in terms of financial and billing concepts. Knowledge of health care compliance, reimbursement and managed care issues.




Must be proficient in Microsoft Word, and Excel. Experience with audit software tools preferred.



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Job Info

Job: 17130

Department: Corporate Compliance
Sub Category: ADMIN PROF
Status: Full Time Benefits Eligible
Shift: D
Hours: 40