Clinical Supervisor

Role Responsibilities

Clinical Supervisor- Medical and Health 4

The Clinical Supervisor is a subject matter expert providing clinical expertise on the review of patient records to assess the appropriateness of physician billing, in compliance with AHCIP. 
Reporting to the Manager of Audit and Compliance Review Services, the Supervisor is proficient in written and verbal communications, leading and mentoring staff, project management, managing complex issues and multiple priorities, and has a good understanding of data analysis.
 

Role Responsibilities:

The Clinical Supervisor will be accountable for the following key responsibilities:
 

• Provide medical subject matter expertise and advice to clinical advisors and other team members, including: Unit auditors, the data analytics team, the policy analysts, and other branches/divisions within the Ministry.
• Supervise, lead, and mentor the team of Clinical Advisors in supporting ACAU practitioner audits and compliance reviews that will have an impact for the health system in terms of financial recoveries, cost savings, and compliance to legislation.
• Assign, monitor, and evaluate Clinical Advisors workload to ensure productive and efficient workflow within the team.
• Contribute to the development and/or influence of enhancing policies, processes and enforcement strategies to promote best practices within the framework of relevant legislation.
• Work with the Manager and other Clinical Supervisors to complete audits and reviews that will have the greatest impact in terms of cost recoveries or savings, compliance with health system principles and legislation or patient and public safety.
• Initiate clinical discussions with internal and external staff (ie. AMA and/or CPSA) to interpret and seek clarification on FFS billing codes, ensure working papers have appropriate documentation to support code interpretations, normal practitioner practices, and other matters to assist in the audit and review process. Foster mechanisms for sharing information and collaboration within the branch and/or virtual teams.
• Engage with other branches for information sharing, including but not limited to business units involved in the schedule of medical benefits, data analytics, claims, alternative relationship plans, and other physician compensation streams.
• Create briefings, background material and responses to Action Requests or other updates needed in alignment with established processes, timelines and guidelines.
• Provide consistent messaging to physicians and outside legal counsels, and provide professional communication with these and other external stakeholders such as regulatory bodies (e.g. CPSA and College of Optometrists of Alberta), professional associations (e.g. AMA) and boards (e.g. Workman's Compensation Board), etc. throughout the course of the work.
• Collaborate with HIU or Law Enforcement on medical fraud investigation as well as external stakeholders (ie. AMA and/or CPSA) to interpret and seek clarification on FFS billing codes.

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

Clinical Advisor- Medical and Health 3

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.
 

Role Responsibilities:

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 and Capital planning 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 - MH3: Facilitates open communication and leverages team skills.
• Build Collaborative Environments - MH4: Collaborates across functional areas and proactively addresses conflict, encourages broad thinking on projects, and works to eliminate barriers to progress. Facilitates communication and collaboration, anticipates and reduces conflict at the outset, credits others and gets talent recognized, promotes collaboration and commitment. 
• Systems Thinking - MH3: Considers inter-relationships and emerging trends to attain goals.
• System Thinking - MH4: Takes a long-term view towards organization's objectives and how to achieve them and a holistic of challenges and opportunities. Anticipates outcomes and potential impacts, seeks stakeholder perspectives. Works towards actions and plans aligned with APS values. Works with others to identify areas for collaboration
• Creative Problem Solving - MH4: Engages the community and resources at hand to address issues, engages perspective to seek root causes and finds ways to improve complex systems. 
• Agility - MH3: Identifies and manages required change and the associated risks.
• Agility- MH4: Identifies and manages required change and the associated risks. Identifies alternative approaches and supports others to do the same, proactively explains impact of changes, anticipates and mitigates emotions of others. Makes decisions and takes action in uncertain situations and creates a backup plan.

Qualifications

Medical and Health 3
 

• Bachelors degree in Nursing and three (3) years of related experience.
• Must be a regulated member of the College 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.
   

Preference will be given to candidates who have the following experience:
 

• Clinical experience with practice guidelines, patient-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 the Schedule of Medical Benefits, Allied Health Practitioners’ schedule of benefits and the Alberta Health Care Insurance Act.
   

Medical and Health 4
 

• Bachelors degree in Nursing and four (4) years of related experience. Must be a regulated member of the appropriate college if required by the Health Professions Act.
• Equivalency: related diploma and six (6) years of related experience. Must be a regulated member of the appropriate college if required by the Health Professions Act.
• Masters degree related to the position assignment and three (3) years of related experience. Must be a regulated member of the appropriate college if required by the Health Professions Act.

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

Assets
 

• Several years of active patient care experience in a health care setting.
• Experience with medical billing records, terminology, and billing codes.
• Experience in a supervisory role.

A cover letter outlining how your experience relates to the qualifications of this role is required.

Notes

This competition will be used to staff Multiple Full-time positions.

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

Location
ATB Place North, 10025 Jasper Avenue, Edmonton, Alberta. This position requires working from the office with an option to qualify for a hybrid work arrangement (in accordance with GOA policy).
 

Other information:

• This position maybe used to fill future vacancies across the Government of Alberta, at equal or lower classification and salary. 
• Top candidates may be required to undergo security screening
   

In your resume, please include dates (including months and years) associated with all education and work experience. Also, please indicate whether your work experience is casual, part time or full time.

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.

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

• Working for the Alberta Public Service – https://www.alberta.ca/advantages-working-for-alberta-public-service.aspx
• Pension plans: 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.
• Opportunity to participate in flexible work arrangements such as working from home up to two days per week and modified work schedule agreements.
• Leadership and mentorship programs.