Overview

Under the direction and supervision of the Professional Revenue Profile Variance Manager, or his/her designee, analyzes professional revenue data specific to Pricing, Claims Reimbursement and Integrity of Payer Contract Management for Yale Medicine. Responsible for ensuring the accuracy of payer fee schedules, system logic and routine maintenance to reduce payment variances. Performs reliable and timely analysis of incorrect payments to ensure maximum recoveries for all carriers. Following through with payment issues until resolution when identifying and escalating payment trends. Through detailed data mining and analysis, monitors and reports on payer contract performance to support contracting objectives. collaborates with and supports Specialty and Payor Liaisons with report generation and analysis of departmental billing and collection activity.

Required Skills and Abilities

1. Exceptional ability to produce, analyze and interpret detailed reports, develop clear conclusions, and summarize and present findings; monitor and analyze payer key performance metrics for YM and individual clinical departments. Working knowledge of EPIC or other Practice Management and Electronic Health Record applications, including knowledge of contract management systems.
2. Exceptional ability to analyze and evaluate documented policies, procedures and operational workflows and recommend process improvements to maximize workflow efficiencies and optimize reimbursement according to payor contracts.
3. Demonstrated ability to work effectively as a team member, develop good working relationships with co-workers, Yale Medicine clinical departments, as well as external provider/vendor representatives. Ability to work, plan, research and conduct projects with minimal supervision. Takes initiative and demonstrates accountability. Comprehensive knowledge of ICD-10, CPT-4, and HCPCS coding, medical terminology and third-party reimbursement policies.

4. Communicate information effectively, both oral and written. Organize and prioritize workload to manage multiple tasks and meet deadlines. Exemplify dependability, reliability and excellent attendance.

5. Customer service oriented, with ability to relate to a variety of levels of audience. Excellent written and oral communication skills with demonstrated interpersonal ability to facilitate a team-based approach.

Preferred Skills and Abilities

1. Proficiency with MS Word and Excel, work related experience in a private or academic setting.

Preferred Licenses or Certifications

1. (AAPC) CPC Certification.

Principal Responsibilities

1. Ensure the integrity of data housed in Epic that is critical to producing accurate Professional Revenue Cycle processes and reporting such as, professional billing codes, pricing, work RVU, provider, department, bill areas, report groupers, etc. Understand the Epic infrastructure and logic for charging, claim production and payment or denial posting. 2. Monitor and resolve charges held in Epic work queues related to pricing. Establish consistent processes to ensure timeliness of code and price activation. Maintain reliable storage of carrier fee schedules. Assist in establishing processes and systems are in place to identify and track all incorrect payments and appeals. 3. Maintain the claims scrubbing system to minimize claim denials and payment delays. Ensure timely review of edit change requests. Perform annual review of existing edits. Run analyses on current charges to determine impact of changes. 4. Manage relations with designated third party contracted payers. Coordinate communications; establish regular meetings in person, by phone or internet to discuss outstanding 'tracker' issues regarding payments, denials or other processes until resolved. Communicate with managed care contracting staff regarding carrier payment performance. 5. Maintain timely distribution of Payer Alerts to all staff involved in the Professional Revenue cycle process. 6. Perform reliable and timely processes and procedures related to Payer Contract Management. Track carrier performance compared to negotiated and ideal contract elements. Identify and monitor variations. Communicate variations from expected and provide suggestions for action. Participate in the development of Yale Medicine Administration (YMA) requirements and improvements in processes to manage payer contracts and performance. 7. Conduct detailed and comprehensive fee schedule analyses to support contract negotiations based on knowledge and access to national, regional and community data. Perform predictive analyses to determine the financial impact of fee schedule changes on the overall practice, individual departments and physicians. Prepare special analyses and reports to develop and support financial recommendations to Clinical Department Chairs and Administrators, YNHHS Contracting and YM Administration to address specific concerns with respect to contracting and reimbursement issues. 8. Provide support to Professional Revenue and Integrity Specialists and Managers on investigative projects to assess changes in billing and collection performance of specific clinical departments or physicians. Suggest queries and provide detail and/or comparative reports of billings, adjustments, payments, rejections and outstanding accounts receivable. Assume project management of major reimbursement projects affecting YMA strategic goals and objectives. 9. Assist in development and maintenance of policies and procedures relevant to contract management and payment analysis. Coordinate review, editing and posting of documents with various YMA staff. Ensure accuracy of information posted on the web. 10. Attend and/or lead meetings and present findings. Regularly communicate with key clinical department and YMA staff and managers as needed or appropriate. Plan, organize, facilitate and communicate results of regular meetings with staff and other YMA department or affiliate practice staff, physicians and/or administrators. Participate on relevant committees. Work with other Professional Revenue Department staff on projects as assigned or appropriate. Required Education and Experience Bachelor's Degree and four years of relevant experience in systems analysis, programming, implementations and the analysis of business needs and development of related business systems, or the equivalent combination of education and experience. Required License(s) or Certification(s) Required Licenses and Certifications Physical Requirements Physical Requirements

Job Posting Date

07/08/2026

Job Category

Professional

Bargaining Unit

NON

Compensation Grade

Administration & Operations

Compensation Grade Profile

Manager; Program Leader (24)

Salary Range

$68,000.00 - $120,500.00

Time Type

Full time

Duration Type

Staff

Work Model

Remote