Payer Audit Business Analyst

Yale New Haven Health System

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.

The Payer Audit Business Analyst monitors Payer Audit metrics by reporting, evaluating, reviewing and trending of government and commercial Payer Audit activities. Utilizes appropriate analytical and statistical methodologies and techniques to measure trends, progress and change. Responsible for reviewing and submitting quarterly the YNHHS RAC data to American Hospital Association (AHA). Responsibilities include tracking and monitoring all new/revised medical records forms that are presented to the System Forms Committee including maintaining a Medical Records forms inventory list. Interacts proactively with multidisciplinary healthcare team in a purposeful and goal directed manner to maximize resource utilization.

  • 1. Actively monitors, validates and authenticates data integrity for all Payer Audit government and Commercial DRG data across the YNHHS. Assists team in development, implementation and maintenance of automated and integrated methodologies for data collection, retrieval presentation, analysis and interpretation. Ensures the quality and integrity of data collected for decision making and works with the other areas of the organization to ensure consistent reporting of information. Analyzes and makes recommendations for improved data quality.
  • 2. Achieves HIM System process optimization objectives by leading process improvement initiatives. Charged with system improvements through the use of analytical skills and knowledge of available data.
  • 3. Prepares and validates monthly Government and Commercial Revenue reports for the YNHHS Revenue Cycle Department. Coordinates and prioritizes time lines to ensure all data is reviewed, completed and reported in a timely fashion. Must keep abreast with all CMS Audit Rules and Regulations for changes that may impact financial reporting.
  • 4. Prepares, validates and distributes quarterly System reports for Compliance, quarterly RAC reports for AHA, and monthly Payer Audit metric reports for Senior HIM management.
  • 5. Assists with IT strategy along with the EPIC team and external software vendors regarding Payer Audit functions and explores opportunities for optimizing systems. Evaluates the effectiveness of Payer Audit operations, utilizing knowledge of Epic and the Payer Audit software applications. Periodically conducts quality assurance reviews on Payer Audit workflow efficiencies and makes recommendation to streamline tasks.
  • 6. Coordinates tracking of all new and revised medical record forms in line with the YNHHS Forms Committee charter. Serves as liaison for Lawrence & Memorial (L&M) and Westerly medical record forms submission and reconciliation with System forms design.
  • 7. Develops and maintains strong relationships with Payer Audit, Utilization Review (UR), and Billing to create an environment that is conducive towards achieving common System objectives and goals.
  • 8. Maintains current knowledge of State and Federal regulatory and payer requirements to perform job responsibilities.
  • 9. Develops and executes educational presentation and training for all Payer Audit staff relative to software applications utilized by the Payer Audit team at both the group and individual level.
  • 10. Develops and updates Payer Audit procedural guidelines.
  • 11. Performs other related duties and projects as assigned by the by the Payer Audit Manager.
  • 12. Adheres and enforces all requirements related to HIPAA and confidentiality, privacy and security of patient records.


Bachelor's degree in Health Information Management, Health Informatics or comparable field required. RHIT, RHIA, or CHDA required within one year in the position.


Three (3) years or more of HIM experience with exposure to auditing/coding/billing with working knowledge of governmental and commercial audits. Knowledge of electronic medical record including Epic. Minimum of two (2) years analytical experience. Experience with compiling data and creating reports with accuracy and in a timely manner.


RHIT, RHIA, or CHDA required within one year in the position.


Knowledge of hospital billing and third party reimbursement methodology with emphasis on government and commercial payers. Must be able to critically think and apply HIM knowledge. Strong analytical skills and excellent oral, written and customer service communication skills are required. Must have the ability to analyze data from conceptualization through presentation of the data; proficiency with analytical tools. Demonstrated proficiency of personal computers, MS Word, MS Excel and Internet Explorer applications.

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Confirmed 2 hours ago. Posted 30+ days ago.

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