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Coverage Change Lead

Company: Yale-New Haven Hospital Saint Raphael Campus
Location: New Haven
Posted on: June 6, 2021

Job Description:

Overview

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.

Reports to the Manager, Receivable Integrity/ QA & Process Optimization, with responsibility for leading all aspects of the Coverage Change staff and their operational workflows. Ensures that staff is adequately prepared to perform job functions using a variety of interrelated computer systems. Provides leadership support and staff development through analyzing and identifying trends associated with problem areas within the revenue cycle. Ensures that staff use proper escalation procedures both internally and externally after exhausting all avenues for timely resolution of accounts. Develops and implements departmental procedures in conjunction with management to improve workflows and provides recommendations for revenue cycle process improvements. Identifies and implements process improvements related to these functions. Performs quality assurance on accounts to ensure that procedures are adhered to and evaluates the effectiveness of the current system and operational practices.

EEO/AA/Disability/Veteran
Responsibilities

  • 1.Acts in a manner consistent with supervisory expectations. Progressively takes on more responsibility for coordinating and leading the team. Motivates and inspires team members to achieve goals through effective coaching and mentoring. Supports team work and communication among all to foster a work environment conducive to collaboration, brain storming, problem solving, risk mitigation and accountability.
  • 2.Ensures staff uses proper escalation procedures both internally and externally after exhausting all avenues for timely resolution of accounts. Provides feedback and instruction regarding clear and concise documentation of account activity.
  • 3.Monitors employee competence on the Epic system and provides feedback regarding effectiveness of staff to management. Works closely with management and staff to address work flow issues and concerns.
  • 4.Participates in the implementation process of all new computer systems, new releases and any other system enhancements throughout the patient account departments. Serves as a resource on the Epic system and provides system fundamentals for Coverage Change team. Develops instructions, manuals and related operational written documentation for all coverage work flows and Epic system releases. Ensures departmental procedures are complete, accurate and current.
  • 5.Retrospectively analyzes accounts to ensure proper methodology has been used. Conducts operational audits of areas within the department to identify departures from policy and of other functional system problems. Make recommendations for improvement to management.
  • 6.Monitors insurance discovery safety net processes with external agents or vendors. Identifies and implements process improvements related to these functions.
  • 7.Communicates with agents or vendors to resolve identified issues, monitor workflows and develop enhancements.
  • 8.Works closely with Receivable Integrity team to identify and catalogue opportunities to improve revenue cycle efficiency as it relates to insurance coverage. Develops QA feedback to both access and billing end users to communicate opportunities for improvement.
  • 9.Performs Q/A and ?Process Optimization? tasks to support global Receivable Integrity projects and meet goals.
  • 10.Supports management in their efforts to enhance employee performance, streamline workflow and improve overall productivity. Develops additional training and education plan as needed.
  • 11.Participates in the interview process and selection of personnel. Provides input and participates in the actual presentation of performance reviews. Able to utilize Kronos to review, edit and authorize the accuracy of employee's hours to be paid.
  • 12.Adheres to Yale New Haven Health Standards of Professional Behavior: Patient-Centered Care, Respect, Compassion, Integrity, and Accountability. Exhibits Outstanding Standards of Professional Behavior at all times and is a role model.
  • 13.Maintains and adds to personal knowledge by keeping informed of billing and coverage policy updates to regulations and procedural changes. Attends meetings and seminars to effectively perform assigned duties. Takes classes at the IFE (i.e. Aspiring Managers).
  • 14.Participates in Steering Committee projects and presentations.
  • 15.Performs all other duties as requested to maintain a smooth operation of the individual departments and contributes to overall group goals.

Qualifications

EDUCATION

Bachelor's Degree Required

EXPERIENCE

Three (3) to five (5) years of experience in a hospital /healthcare revenue cycle electronic accounts receivable environment. Experience should include extensive computer skills, training and resolving complex issues regarding healthcare coverage. Must have experience coordinating or leading teams.

LICENSURE

Revenue Cycle certification (i.e. AAHAM CRCS) required within 18 months of hire.

SPECIAL SKILLS

Excellent interpersonal, analytical, organizational and communication (oral and written) skills. Extensive computer skills and ability to utilize software programs to monitor activity and develop statistical reports for purposes of tracking quality assurance. Extensive knowledge of third party insurance carriers and their billing and eligibility platforms. Ability to interpret guidelines established by health care industry and government agencies. Strong teamwork and interpersonal skills at all management levels.

YNHHS Requisition ID

28075

Keywords: Yale-New Haven Hospital Saint Raphael Campus, New Haven , Coverage Change Lead, Other , New Haven, Connecticut

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