Clinical Advisor

Role Responsibilities

The Clinical Advisor is responsible for applying clinical professional expertise to compliance determinations in the assessment of various compliance reviews and audits regarding AHCIP claims, health services utilization concerns, and suspected inappropriate claim practices.

Reporting to the Clinical Supervisor, the Advisor is proficient in written and verbal communications, is able to collaborate and influence staff and stakeholders to achieve positive outcomes.

The main responsibilities of the Clinical Advisor are:

•    Apply clinical professional expertise to decide on the compliance of health billing events performed by a wide range of practitioners, within the regulatory application of the AHCIP and related authorities.
•    Provide clinical interpretations and advice to other team members, namely: auditors within the unit, the data analytics team, other branches/divisions within the Ministry, as well as internal legal counsel, and the Health Investigations Unit (HIU) of Service Alberta in criminal cases.
•    Provide clinical interpretations and advice to influence the behavior of multiple external stakeholders such as the practitioner and their staff that are subjects of the reviews and audits, the Alberta Medical Association (AMA) and the College of Physician and Surgeons (CPSA). As an example, educating providers and their employees about acceptable claim practices and utilization rates to proactively encourage compliance.
•    Collaborate with other team members and staff in completing ACAU compliance reviews and audits with the understanding of how the clinical review work relates to others in impacting the health system in terms of financial recoveries, cost savings, and compliance to legislation.
•    Identify and escalate issues related to billing rules and/or practices in need of change, such as where rules are unclear, misinterpreted, or abused.
•    Manage multiple compliance reviews concurrently, as well as audits, special projects, and contributions of advice to others on clinical matters.
•    Apply creative problem-solving skills to plan approaches for compliance reviews and audits that involve understanding new areas where ACAU has no prior history. For example, compliance reviews extend beyond General Physicians to encompass roles where billing risks have increased, such as Radiologists, Psychiatry, and Ophthalmologists, as well as clinics involving multiple practitioners and new business models (i.e. Private Member Clinics).

If you are ready to seize this exciting opportunity to make an impact within the Finance division, please apply today, we would like to meet you!

Please click on this link to view the job description for this position.

APS Competencies

Competencies are behaviors that are essential to reach our goals in serving Albertans. We encourage you to have an in depth understanding of the competencies that are required for this opportunity and to be prepared to demonstrate them during the recruitment process.

This link will assist you with understanding competencies:
https://www.alberta.ca/system/files/custom_downloaded_images/psc-alberta-public-service-competency-model.pdf.

•    Build Collaborative Environments: Facilitates open communication and leverages team skills.
•    Systems Thinking: Considers inter-relationships and emerging trends to attain goals.
•    Agility: Identifies and manages required change and the associated risks.

Qualifications

•    Bachelor’s degree in nursing and three (3) years of related experience.
•    Must be a regulated member of the Collage of Registered Nurses of Alberta (CRNA)

Equivalency: Related diploma and five (5) years of related experience. Must be a regulated member of the appropriate college as required by the Health Professions Act. 

Requirements:
•    Experience using MS Word, MS Excel and Adobe PDF with proficiency is required.
•    Experience carrying out compliance reviews is required.

Preferences will be given to candidates who have the following experience:
•    Clinical experience with practice guidelines, patients-case documentation.
•    Processes, medical terminology and medical and surgical procedures.
•    Experience reviewing and analyzing various medical documents and reports. 

The following will be considered as assets:
•    Knowledge of current information issues, trends, research and technologies within public health.
•    Experience with Schedule of Medical Benefits, Allied Health Practitioners’ schedule of benefits and the Alberta Health Care Insurance Act.

Minimum recruitment standards outline the minimum education and experience required for appointment to a job classification. 

Refer to https://www.alberta.ca/alberta-public-service-minimum-recruitment-standards.

Notes

This competition will be used to fill two full-time permanent positions.

Hours of Work:
7.25 hours daily / 36.25 hours weekly, Monday to Friday

Location:
ATB Place North, 10025 Jasper Avenue, Edmonton, AB.

•    Final candidates may be required to undergo a security screening.
•    Any costs associated with obtaining the required documents/checks as noted or interview travel expenses, will be the responsibility of the candidate. Out-of-province applicants can obtain the required documents/checks from the province they currently reside in.

A cover letter outlining how your experience relates to the qualifications of this role is recommended to assess your writing skills.

In your resume, please include dates (including months and years) associated with all education and work experience. For example, January 2006 – June 2009 (part-time). This example is provided for illustrative purposes only. Applicants are encouraged to present their information clearly and thoroughly, using a format that best conveys their experience.

Links and information on what the GoA have to offer to prospective employees.

•    Working for the Alberta Public Service - https://www.alberta.ca/advantages-working-for-alberta-public-service.aspx.
•    Public Service Pension Plan (PSPP) - https://www.pspp.ca.
•    Management Employees Pension Plan (MEPP) - https://www.mepp.ca.
•    Alberta Public Service Benefit Information - https://www.alberta.ca/alberta-public-service-benefits.
•    Professional learning and development - https://www.alberta.ca/professional-development-support-directive.
•    Research Alberta Public Service Careers tool – https://researchapscareers.alberta.ca.
•    Positive workplace culture and work-life balance.
•    Leadership and mentorship programs.