YCCI Research Billing Compliance Analyst

Job Description
1.  Primary responsibilities include the completion of risk assessments on all MQT trials with billable services. The level of risk is determined utilizing the CTMS (OnCore) risk assessment tool as well as the clinical trial documentation and information provided within the study’s protocol.  Once the risk assessment is complete and all trials scored, random selection of the highest risk trials will be assessed and reviewed for accurate research billing compliance and proper medical documentation.2.  Medical documentation, coding and billing will be evaluated for accurate ICD-10, CPT-4, HCPC and modifier placement in compliance with University and government regulations. 3.  Identify potential clinical research charges not specifically defined in research protocols.  Work collaboratively with the Office of Sponsored Projects to determine proper documentation alignment including but not limited to the informed consent forms, research protocols, clinical trial agreement and trials finalized budget.  4.  Review all billable services/encounters for designated studies utilizing OnCore and Epic. Communicate and supply YNHHS Compliance department with ongoing reviews and assist with any information requested in order to ensure accurate and consistent billing for both professional and hospital charges.  5.  Evaluate findings, identify system control weaknesses and in conjunction with department management, assist in the development of a corrective action plan for Principal Investigator and study team. Assist in the implementation and follow up of all corrective action changes.  6.  Maintain accurate logs, including spreadsheets, of all ongoing investigations. Enter all review findings in the OnCore registry database   Identify and analyze any trends and report findings to the Associate Director, Research Billing Compliance.7.  Assist in the conduction of research training sessions with Principal Investigators and research related study teams and personnel.  Provide subject matter expertise and input on areas where education is needed.   Assist in the development of training materials and programs for research billing compliance, including but not limited to accurate coding, documentation billing and regulatory guidelines.8.  Conduct data analysis.  Generate reports using OnCore reporting tools to identify trends and problem areas for focus of internal reviews.9.  Assist and support with the ongoing implementation of the Research Billing Compliance Program as well as knowledge retention and maintenance of the Yale School of Medicine’s Research Billing Compliance Plan, operations and procedures.  10. Stay abreast of best practice coding and billing initiatives as well as all pertinent regulatory changes. Maintain CPC designation by obtaining necessary CEUs on an annual basis.   

Required Education and Experience
Bachelor’s Degree in Health or Business Administration or a related field and 3 years of experience working directly with clinical research charge review and billing or an equivalent combination of education 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 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.

Position Focus:
Coordinate and conduct research billing reviews for all randomly selected clinical trials with billable services based on risk. Complete risk assessments, billing reviews, assist with training for Principal Investigators and their associated study teams. Provide feedback and reports to the Associate Director, Research Billing Compliance on all finding identified during the billing reviews.

Preferred Education, Experience and Skills:
Ability to interpret operative and procedural reports as well as working knowledge of Evaluation and Management (E&M) documentation guidelines (1995, 1997) and E&M audit practices to determine appropriate level of service and code assignment.  Proficient knowledge of CMS, NCCN and Local guidelines and regulations.

Preferred Licenses or Certifications:
Certified Professional Coder (CPC) credentials.

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.

University policy is committed to affirmative action under law in employment of women, minority group members, individuals with disabilities, and protected veterans. Additionally, in accordance with Yale’s Policy Against Discrimination and Harassment, 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).

Required Skill/Ability 1:
Comprehensive working knowledge of ICD-10, CPCT-4, or HCPCS coding and research billing practices.

Required Skill/Ability 2:
Demonstrated ability with both Epic, OnCore, MS Word, Excel. Ability in clinical research billing and review.

Required Skill/Ability 3:
Ability to analyze and communicate effectively.