Corewell Health
Prospective Payment Specialist Coordinator
Corewell Health, Watervliet, Michigan, United States, 49098
Reimbursement Specialist
Responsible for ensuring optimal reimbursement through analytical review of medical records and collaboration with interdisciplinary teams, including billing, coding, and medical team members. Also responsible for obtaining necessary prior authorizations, submitting documentation to appeal denials, and educating clinicians regarding proper documentation for all Inpatient Rehabilitation locations. Essential Functions: Acute Rehabilitation setting: Responsible for all aspects of IRF-PAI tool including transmission of records to the Centers for Medicare and Medicaid Services (CMS) and other insurances as needed. Monitor and educate clinicians on documentation quality and compliance to improve clinical outcomes, and maximize reimbursement. Collaborate with coding, billing, denials and other departments as needed. Monitor CMS/insurance updates, regulations and educate staff as needed. Subacute Rehabilitation setting: Responsible for communication with appropriate health insurance companies regarding authorizations and denials. Executes standard work regarding Medicaid appeals/denials, change requests, and all insurance authorizations. Educates medical staff/other health professionals regarding billing, coding and quality requirements. Makes recommendations and provides medical and insurance information to team members to facilitate work prioritization. Identifies quality indicators to facilitate process improvement and physician education. Responsible for compliance perspectives of rehabilitation team by completing chart audits and daily manual pull to review accuracy in documentation timelines. Performs audits and quality review duties as assigned by Administrator or Rehab Manager/Director. Responsible for the generation, interpretation and analysis of reports. Monitors insurance coverages and assist with completion of insurance re-certifications Collaborates with interdisciplinary team on overall plan of care Qualifications: Required Associate's Degree (or equivalent education and experience) Preferred Bachelor's Degree 2 years of relevant experience Health care, preferably in inpatient acute and/or sub acute rehabilitation Required Familiarity with different diagnostic groups for Case Mix Group (CMG) selection and IRF-PAI tool. Preferred Experience with quality reporting, coding experience and reimbursement systems for inpatient acute and/or subacute rehabilitation Preferred Experience with medical documentation and electronic medical records Required LIC-Physical Therapist Assistant - STATE_MI State of Michigan Upon Hire required Or CRT-Occupational Therapy Assistant, Certified (COTA) - NB-COT National Board for Certification in Occupational Therapy Upon Hire required About Corewell Health: As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
Responsible for ensuring optimal reimbursement through analytical review of medical records and collaboration with interdisciplinary teams, including billing, coding, and medical team members. Also responsible for obtaining necessary prior authorizations, submitting documentation to appeal denials, and educating clinicians regarding proper documentation for all Inpatient Rehabilitation locations. Essential Functions: Acute Rehabilitation setting: Responsible for all aspects of IRF-PAI tool including transmission of records to the Centers for Medicare and Medicaid Services (CMS) and other insurances as needed. Monitor and educate clinicians on documentation quality and compliance to improve clinical outcomes, and maximize reimbursement. Collaborate with coding, billing, denials and other departments as needed. Monitor CMS/insurance updates, regulations and educate staff as needed. Subacute Rehabilitation setting: Responsible for communication with appropriate health insurance companies regarding authorizations and denials. Executes standard work regarding Medicaid appeals/denials, change requests, and all insurance authorizations. Educates medical staff/other health professionals regarding billing, coding and quality requirements. Makes recommendations and provides medical and insurance information to team members to facilitate work prioritization. Identifies quality indicators to facilitate process improvement and physician education. Responsible for compliance perspectives of rehabilitation team by completing chart audits and daily manual pull to review accuracy in documentation timelines. Performs audits and quality review duties as assigned by Administrator or Rehab Manager/Director. Responsible for the generation, interpretation and analysis of reports. Monitors insurance coverages and assist with completion of insurance re-certifications Collaborates with interdisciplinary team on overall plan of care Qualifications: Required Associate's Degree (or equivalent education and experience) Preferred Bachelor's Degree 2 years of relevant experience Health care, preferably in inpatient acute and/or sub acute rehabilitation Required Familiarity with different diagnostic groups for Case Mix Group (CMG) selection and IRF-PAI tool. Preferred Experience with quality reporting, coding experience and reimbursement systems for inpatient acute and/or subacute rehabilitation Preferred Experience with medical documentation and electronic medical records Required LIC-Physical Therapist Assistant - STATE_MI State of Michigan Upon Hire required Or CRT-Occupational Therapy Assistant, Certified (COTA) - NB-COT National Board for Certification in Occupational Therapy Upon Hire required About Corewell Health: As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.