Coverage Change Lead
Company: Yale-New Haven Hospital Saint Raphael Campus
Location: New Haven
Posted on: June 6, 2021
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.
- 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
- 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
- 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
- 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
- 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
- 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
- 14.Participates in Steering Committee projects and
- 15.Performs all other duties as requested to maintain a smooth
operation of the individual departments and contributes to overall
Bachelor's Degree Required
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.
Revenue Cycle certification (i.e. AAHAM CRCS) required within 18
months of hire.
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
YNHHS Requisition ID
Keywords: Yale-New Haven Hospital Saint Raphael Campus, New Haven , Coverage Change Lead, Other , New Haven, Connecticut
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