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Hourly Range

31.05

Overview Under the direction and supervision of the Associate Director and Team Lead/Manager, employee will be responsible for insurance follow-up on denials from Yale Health Plan, Workers Compensation and MVA payers as well as charge review, credit and claim edit work queues. Follow up of denied claims for Yale Medicine and its related specialties and practices. Follow up denials, resolve claim edits and credits for assigned payers following process guidelines established by the Central Business Office management team. Review carrier denials or letters to analyze next steps needed to ensure payment. Review payment history. Review, work and resolve delinquent accounts with supervisor and collection agency. Recommend and implement changes to system and operation procedures. Compose form letters and correspondence used in account receivable activities. Knowledge of appealing denials in order to receive maximum reimbursement for Yale Medicine. Write, send and follow up on appeals as appropriate by contacting the carrier, researching carrier policies, review of medical documentation and/or work collaboratively with YM staff to ensure maximum reimbursement. Directly communicate with third party insurance carriers, patients, and other listed payers in order to investigate payment/reimbursement delays for billed charges, for both primary and secondary claims. Respond to requests from insurance carriers, Yale Medicine clinical departments and/or patients for supporting documentation necessary in order to obtain maximum reimbursement. Work closely with other centralized and non centralized units within the Business Office to resolve outstanding claim/billing/payer issues or requests. Identify and report carrier/specialty issues that will assist in claim processing and resolution. Responsible for documentation and follow up of claims worked through payment, rejection or appeal. Strong knowledge of insurance carrier and specialty related issues. Review and validate charge review and claim edits as assigned to ensure correct coding and in compliance with Yale Medicine guidelines. Ability to review and understand medical records and coding. Interact with all Yale Medicine departments as required to resolve matters relevant to coding, fees, medical documentation and other problems to expedite the processing of claims, payments and rejections. Special projects assigned by Yale Medicine staff and management and all other job related duties. Required Skills and Abilities 1. Knowledge and working experience with CPT, ICD10, HCPC, modifiers, National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edit’s (MUE’s). 2. Working knowledge and experience with Microsoft Office especially Excel and Word. 3. Working experience of EPIC and EPIC work queues. PC data entry experience. 4. Ability to work independently and part of a team. Ability to multi-task in a high-volume environment. Strong verbal and written communication skills. 5. Excellent attendance and reliability. Must be highly energetic and motivated with the ability to work under pressure and handle and maintain a high volume of accounts. Preferred Education, Experience and Skills Experience resolving worker’s compensation & motor vehicle accident claims & rejections including corresponding with those payers as well as attorneys.

Principal Responsibilities

1. Serves as a principal source of information on rules and procedures governing University accounts receivable. Oversees and instructs support staff. 2. Oversees maintenance of account files, ensuring accuracy and completeness. Reviews payment histories. 3. Resolves problem and delinquent accounts with supervisor and collection agency. Assists with final review and disposition of problem accounts. 4. Recommends and implements changes to systems and operating procedures. Composes form letters and correspondence used in accounts receivable activities. 5. Researches individual accounts. Summarizes findings in reports. Completes and processes forms. Performs clerical functions incidental to account activity. Required Education and Experience Four years of related work experience, two of them in the same job family at the next lower level, and high school level education; or two years of related work experience and an Associate's degree, or an equivalent combination of experience and education.

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.

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

The hiring rate of a role is determined in accordance with the provisions outlined in the respective collective bargaining agreement.

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

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.

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