Clinical Advisor - Edmonton, Canada - Government of Alberta

Government of Alberta

Verified Company

Edmonton, Canada

3 weeks ago

Posted by:

Sophia Lee

beBee Recruiter

Description

Job Information:

Job Requisition ID: 43795

Ministry:
Health

Location:
Edmonton

Full or Part-Time:
Full Time

Hours of Work: 36.25 hours per week

Regular/Temporary:
Regular

Scope:
Open Competition

Closing Date:
June 27, 2023

Classification:
Medical and Health 3

About Us:

The Ministry of Health sets policy and direction to achieve a sustainable and accountable health system to promote and protect the health of Albertans.

For more information on the work Alberta Health does, visit this link:

The Audit and Compliance Assurance Unit (ACAU) in the Compliance and Monitoring Branch provides compliance, monitoring and performance oversight to improve quality and accountability of health practitioners' claims for benefits under the Alberta health Care Insurance Plan (AHCIP).

ACAU conducts audits of practitioner submitted claims for benefits, reassessments of claim benefits, and recoveries of overpayments, promotes best practices, and monitors practitioner's adherence to legislation, policies and processes.

The majority of health care practitioners under the AHCIP are physicians paid by fee-for-services.

The ACAU is made up of three teams that work collaboratively: Data Analytics and Monitoring, Audit and Compliance Review Services, and Business Processes, Standards and Reporting.

The team safeguards public funds by assessing provider and recipient compliance to relevant Alberta provincial legislation, regulations, and governing rules through investigations and sophisticated data analysis techniques.

Compliance review work is derived through on going monitoring, anomalies in billing, public tips, complaints, and risk assessments.

Clinical Advisors in the team provide clinical expertise and interpretation of medical documentation. The team engages with health care practitioners and corporate entities in the execution of audits.

Role:

We are looking for a Clinical Advisor to join the Audit and Compliance Review Services Team within ACAU to help safeguard public funds by assessing provider's compliance with billing requirements and taking steps to remedy non-compliance.

Strong attention to detail and analytical skills are required to provide in-depth analysis of specific claims information and provide quality assurance of team deliverables.

Expert knowledge of medical terminology, and medical and surgical procedures is necessary to review medical documentation supporting claims for benefits and determine if they are compliant with Legislation, Regulation, and the Schedule of Medical Benefits.

The Clinical Advisor documents findings in an accurate, thorough and detailed manner, while remaining objective, impartial, and consistent when reporting findings.

The Clinical Advisor will provide information and make recommendations based on the information and facts gathered by the team.

The position must demonstrate a strong knowledge of appropriate legislations, health service codes, policies and procedures (e.g. Health Information Act, Freedom of Information and Privacy Act). Working within the parameters of regulatory bodies, familiarity with the clinical review process would be considered an asset.

The Clinical Advisor will also utilize strong analytical skills to translate information into current and future priorities, contribute to new or enhanced policies and processes/enforcement strategies in order to promote best practices.

Qualifications:

University degree in Nursing and a minimum of three years of related experience is required.

Must be a regulated member of the College of Registered Nurses of Alberta (CRNA).

Experience using MS Word, MS Excel and Adobe PDF with proficiency is required.

Experience carrying out compliance reviews is required.

Clinical experience with practice guidelines, patientcase 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.

The following equivalencies will be considered:

Diploma related to the position assignment and five (5) years of related experience. Must be a regulated member of the appropriate college (CRNA) as required by the Health Professions Act.

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.

The link below will assist you with understanding competencies:

Systems Thinking:
Considers inter-relationships and emerging trends to attain goals.

Drive for Results:
Works to exceed goals and partner