Clinical Department Liaison

Clinical Department Liaison

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Salary Range: $68,000.00 - $120,500.00

Overview

Reporting to the Manager, Clinical Operations, the Clinical Department Liaison serves as the primary strategic and operational bridge between the Department of Psychiatry and Yale Medicine (YM). This position is accountable for independently addressing the department's clinical revenue cycle and compliance concerns, identifying and resolving issues affecting the professional clinical revenue stream, and implementing measures to minimize financial and operational risks while optimizing the efficiency of charge capture for billable services. As a high-level individual contributor, the Liaison coordinates with clinical teams and YM to facilitate new workflows, troubleshoot Epic-related issues, and resolve inquiries from providers regarding training, documentation requirements, and coding.

Serving as the departmental subject matter expert for EPIC, documentation, and coding, the Liaison performs regular audits to identify areas of vulnerability, assess risk, and ensure adherence to compliance standards. They act as a primary educator for faculty and staff on evolving regulatory guidelines and are responsible for staying abreast of all federal, state, and payer/carrier regulations. By maintaining practice locations, managing preference lists, and providing leadership with technical analysis to determine future clinical financial performance, the Clinical Department Liaison ensures that all operational activities align with Yale Medicine's standards.

1. Collaborate with Central YMA at the Department level to improve clinical workflows that may affect charge capture or result in denials.

2. Coordinate preference list/charge capture changes needed between the providers and the Epic Analysts.

3. Develops, implements, and monitors policies and procedures to optimize provider reimbursement. Functions as a resource and educator for clinical department physicians and all appropriate staff on billing and coding issues.

4. Performs documentation and coding audits, assesses risk and communicates findings

5. Review physician productivity and billing data regularly and provide comprehensive detailed summary of findings to departmental leadership including approaches to enhance efficiencies and overall reimbursement of clinical services. Perform analysis to monitor performance, identify trends and areas of concern.

6. Responsible for identifying and notifying YMA of any new procedures that will be performed in their department. This includes coding, pricing and wRVU assignment with expected reimbursement. Provide clinical evidence to support desired RVU values for new or unlisted services.

7. Coordinate creation of new bill areas with the EPIC team, YMA and department finance for appropriate charge linkage and revenue mapping.

8. Monitors and enforces compliance with YMA Policies and Procedures, Practice Standards, HIPAA regulations and Billing Compliance standards throughout all operational activities.

9. Serve as subject matter expert for the department and is responsible for staying abreast of all federal, state, and payer/carrier guidelines and regulations.

10. Attendance at regular meetings with YMA representatives to discuss findings specific to standard reports, coding, payers, Epic workflow, focused reviews, etc.

11. Coordinate with YMA, faculty and/or management any departmental response needed to comply with carrier policy changes.

12. Serve as subject matter expert for EPIC

13. Coordinate with the YM/YNHH Credentialing Team to ensure appropriate set up for new providers, assist with updates to existing providers as clinical work changes

14. Responsible for notifying Credentialing and YMA Central Billing Office of new provider anticipated services, Billing Department, Billing Areas, Revenue Departments, etc.

15. Monitor training compliance for all providers, coordinate live training sessions, work with YM

16. Work in collaboration with YMA Training to organize training efforts for new faculty and staff. Develop training or educational programs and working manuals on procedural guidelines and implementation of new regulatory standards and initiates changes as contracts and regulations change.

17. Monitor ongoing compliance and aide in the development of training modules. Coordinate live sessions throughout the year for different disciplines within the department.

18. Establish a screening process for patients seeing embedded behavioral health providers to ensure insurance transparency. Identifying patients at risk of out-of-network billing and coordinating with administrative teams to implement a notification system.

19. Assist providers with individual agreements with behavioral health carve out carriers and secure single case agreements where needed.

20. May perform other duties as assigned.

Required Skills and Abilities

1. Demonstrated work experience with medical billing and coding.

2. Demonstrated work experience with EPIC or other EMR systems.

3. Strong analytical and problem-solving skills with the ability to identify trends and resolve operational issues.

4. Excellent communication and training skills to educate faculty and staff on policies, procedures, and regulatory requirements.

Principal Responsibilities

1. Works closely with subject matter experts and client groups for projects or programs of a medium to large size to consult, conduct analysis, and identify business objectives and solutions.

2. Identifies core customer business issues and provides solution recommendations to address them. Develops necessary tools and workshops to successfully identify issues and evaluate recommendations.

3. Gathers, receives and interprets data, analyses, and reports. Develops reporting modules, ad-hoc reports, and related reporting tools. Conducts research, data gathering, data analysis, modeling, projecting and scenario analyses, with the aid of planning technology and databases. Develops and harnesses the data that is available to identify existing business issues and key drivers and develops solutions and initiatives.

4. Evaluates data gathered from multiple sources in order to support the issues, conclusions and recommendations.

5. Analyzes data with standard methods, interprets the results, and provides written summary and reporting of analysis.

6. Develops and validates queries for the successful extraction of appropriate data.

7. Develops and maintain documentations and libraries on key processes.

8. Ensures accuracy to maintain the high quality and integrity of information, data and databases.

9. Contributes to the development of unit and/or University plans and strategies. Researches, gathers data and provides recommendations.

10. Collaborates with key stakeholders and subject matter experts to establish the vision, analyze costs and benefits and support implementation. Ensures strategic and tactical plans are carried out.

11. Communicates effectively the perspective of business opportunities, needs, and risks.

12. May perform other duties as assigned.

Required Education and Experience: Bachelor's Degree. Four years of related experience or equivalent combination of education and experience.