- Alberta Health
- $3,143.66 - $4,005.50 bi-weekly
- Job Category
- Job Type
Medical and Health 3
Alberta Health, Edmonton. The Government of Alberta is committed to a diverse and inclusive public service that reflects the population we serve to best meet the needs of Albertans. Consider joining a team where diversity, inclusion and innovation are valued and supported. For more information on diversity and inclusion, please visit: https://www.alberta.ca/diversity-inclusion-policy.aspx
To learn more about Alberta Health and what we have to offer, follow this link: http://www.health.alberta.ca/
Come put your investigative skills, medical expertise and interest in compliance to work in our Audit and Compliance Assurance Unit in the Compliance and Monitoring Branch.
Reporting to the Team Lead, as Clinical Advisor, you would be responsible for providing relevant medical expertise in the completion of compliance reviews of Alberta Health Care Insurance Plan (AHCIP) claims, health service utilization, and suspected inappropriate or fraudulent claim practices. Strong attention to detail and analytical skills are required to provide in-depth analysis of specific claims data and provide quality assurance of team deliverables. Expert knowledge of medical terminology and medical and surgical procedures is necessary to review medical documentation in conjunction with claims for benefits to determine appropriate payments.
The Clinical Advisor will use tact and diplomacy to communicate, both internally and externally, during the course of compliance reviews and audits. By using professional judgment and sound problem solving skills, this role is key in providing clinical interpretations of the medical aspects of the compliance reviews or audits. The Clinical Advisor will document findings in an accurate, thorough and detailed manner, while remaining objective, non-judgemental, and consistent when making observations, providing information, and making recommendations based on the data and facts gathered.
Strong teamwork skills and personal self-awareness are key assets for this role. Although the bulk of the work entails independent file work, the successful candidate will work with differing teams of various professional backgrounds on multiple files concurrently. This role requires strong interpersonal skills to share information, provide advice and transfer knowledge regarding clinical information (e.g., medical treatments, surgical procedures, and required documentation) with unit staff and other Alberta Health staff as needed.
The Clinical Advisor will see their contributions through collaboration with other team members and Unit staff in completing compliance reviews and audits. They will strive to provide the highest level of quality clinical review work, and see the results of their work and team collaboration in positively affecting the health system in terms of financial consequences, cost recoveries and compliance to legislation.
The successful candidate will demonstrate the following APS Competencies:
System thinking - Compliance reviews safeguard public funds by promoting compliance to the applicable legislation related to the AHCIP.
Creative Problem Solving - Identify innovative and effective solutions to ensure compliance to legislation, regulations and governing rules through investigations.
Agility - Anticipate, assess, and readily adapt to changing priorities, maintain resilience in times of uncertainty and effectively work in a changing environment.
Drive for Results - Effectively manage numerous compliance reviews by conducting on-site audits of provider offices/hospitals to retrieve medical records, review records, communicate, negotiate and provide education as needed.
Build Collaborative Environments - Lead a team of Compliance Analysts and collaborate across divisions/units to support Ministry/branch objectives.
Salary: $3,143.66 - $4,005.50 bi-weekly. Closing Date: September 29, 2019. Job ID #1055583
Qualifications: A University degree in Nursing supplemented with a minimum of 3 years of recent and directly related experience is required. Current registration with CARNA is required.
Investigative experience is strongly desired. Experience with the Schedule of Medical Benefits, allied health practitioners' schedules of benefits and/or the Alberta Health Care Insurance Act would be considered assets. Experience with medical terminology and/or medical and surgical procedures is also an asset.
Equivalencies will be considered: Diploma related to the position and a minimum of 5 years of recent and directly related experience is required. Must be a regulated member of the appropriate college as required by the Health Professions Act.
Competencies are behaviours 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: http://psc.alberta.ca/APSCompetencies
Notes: Hours of work: 36.25 per week
Please note: ability to travel and a valid driver's license is required.
What we offer:
- Comprehensive benefits plan: URL
- Pension plan: URL
- Leadership and mentorship programs
- Professional learning and development
- Positive workplace culture and work-life balance
To apply online, users will be required to have an online account: https://www.alberta.ca/navigating-online-jobs-application.aspx
If you are unable to apply online, please submit your cover letter and resume, quoting the Job ID, to: Liliane Karara, TAM Administrator, 8th Floor Park Plaza Bldg, 10611 98 Avenue, Edmonton AB T5K 2P7. Phone: 780-643-1093.
As only one file can be uploaded, please ensure your cover letter, resume and any other related documents are submitted in one file using the following suggested naming convention: Lastname,Firstname_JobIDXXXXXXX
Applicants are advised to provide information that clearly and concisely demonstrates how their qualifications meet the advertised requirements.
It is recommended that applicants who have obtained educational credentials from outside of Canada and have not had them previously assessed, obtain an evaluation of their credentials from the International Qualifications Assessment Service (IQAS)
It is recommended that applicants include the assessment certificate from IQAS or any other educational assessment service as part of their application.
Tips for Applicants: https://www.alberta.ca/alberta-public-service-hiring-process.aspx
We thank all applicants for their interest. All applications will be reviewed to determine which candidates' qualifications most closely match the advertised requirements. Only individuals selected for interviews will be contacted.
If this competition is closed as per the closing date noted above, please continue to check http://www.jobs.alberta.ca for a listing of current career opportunities with the Government of Alberta.
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