Director of Revenue Compliance

• 1. Oversees the auditing staff who conduct routine monitoring and education for New Haven Health System and Northeast Medical Group providers' coding, billing, and documentation. Supervises the billing compliance efforts of Yale New Haven Health System. Collaborates with billing colleagues across the system on compliance matters.
• 2. Develops and implements risk assessment tools to identify areas of potential liability related to professional and hospital medical record documentation practices, charge capture mechanisms, coding efforts and billing activities. Participates in the Enterprise Wide Risk Assessment and compliance work plan process collaborating with Internal Audit, Finance, and Legal on joint tasks.
• 3. Leads efforts related to the Revenue Cycle Compliance audit work plan, based upon results of the Enterprise Wide Risk Assessment, other reviews, and industry guidance.
• 4. Develops and implements clinician training programs where necessary in areas such as medical visit and procedural documentation practices, and compliance with teaching physician rules
• 5. Oversees the development of educational tools to assist providers in documentation efforts, specifically targeting challenging areas for billing compliance and partners with the Associate Compliance Officer to ensure that educational tools are meeting compliance needs.
• 6. Develops proficiency assessment measurement systems, and improvement initiatives related to medical visit, procedure, and diagnosis coding, patient record documentation, and teaching physician regulation compliance.
• 7. Assists department chiefs/chairs and administrators develop departmental compliance efforts. Ensures consistency between Yale New Haven Health System and Northeast Medical Group revenue compliance efforts. Collaborates on communications with Yale Medical Group Compliance Officer
• 8. Monitors billing practices and is the responsible compliance staff member that handles and coordinates revenue or other financial compliance related investigations conducted by external auditors such as NGS, DSS, OIG or other governmental agencies.
• 9. Collaborates with the Billing Office, Patient Accounts, Chargemaster, Audit, Compliance and Revenue Integrity, and the Legal and Risk Services Department, on billing compliance issues.
• 10. Investigates reported noncompliance and resolves problems on a timely basis.
• 11. Supervises, facilitates development, hires, trains, and conducts performance management activities for compliance professionals and clerical support personnel in staffing the Revenue Cycle Compliance team in coordination with the Chief Compliance & Privacy Officer
• 12. Collaborates with compliance representatives within the Office of Privacy and Corporate Compliance to develop effective shared risk compliance models for physicians.
• 13. In consultation with the Chief Compliance & Privacy Officer, recommends modifications to overall billing compliance efforts to enhance effectiveness. Establishes goals and objectives for the department; develops policy and practices, procedures for compliance and auditing activities; directs and controls both the technical and administrative functions.
• 14. Works to develop strong relationships across the System with key departments including YMG Compliance Director, Internal Audit, Epic/ITS, JDAT, Legal, Revenue Management, SBO and clinical department leaders.
• 15. Participates in outside healthcare compliance organizations to stay abreast of corporate compliance developments and best practices within the industry.
• 16. Actively participates in departmental and team meetings.
• 17. Strives to continually improve the compliance program.
• 18. Responsible for supervision, staff development, and training of OPCC staff positions.
• 19. Develops personal and departmental goals and objectives consistent with those of the Yale New Haven Health System in conjunction with the Chief Compliance & Privacy Officer.
• 20. Coordinates with legal counsel and management to maintain appropriate privacy and confidentiality, related to attorney client privileged information.

EDUCATION

Bachelor's and Master's degrees required in nursing or another clinically focused area, business administration, healthcare administration, or a related field of study. CPT and ICD-10-CM proficiency. Demonstrated success in provider training and skills in change management and adult learning methods.

EXPERIENCE

Five to seven years experience in hospital and physician practice coding, charging, and billing required.
Experience with faculty practice plan and academic training program required.
Knowledge of Medicare and Medicaid billing regulations and fraud and abuse laws required.

LICENSURE

CCS, CPC, RHIA or equivalent coding certification preferred, CHC or other compliance certification required. Registered nurse or allied health professional license, helpful.

SPECIAL SKILLS

Ability to lead a team of seasoned compliance professionals in delivering exceptional revenue compliance services to Yale New Haven Health System and Northeast Medical Group clinicians and administrators.
Superior communication skills in designing and delivering effective billing compliance training programs. Demonstrated skills in working with external regulators and private payers in resolving audits in an appropriate and expedient manner. Demonstrated understanding of compliance issues related to ambulatory and hospital services, business administration, billing requirements for private insurers, and federal programs and Medicare Part A&B billing requirements. Demonstrated leadership skills and effectiveness. Ability to research and interpret regulatory requirements and coordinate and monitor internal responses complaints, audits and investigations. Demonstrated organization, facilitation, communication and presentation skills. Ability to prioritize and plan work independently. Ability to interact with all levels of management.

PHYSICAL DEMAND

Standard office environment. Some travel may be required.