Prospective Payment Specialist Coordinator

Job Summary

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

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, travel, and more!
• Optional identity theft protection, home and auto insurance, and pet insurance
• Traditional and Roth retirement options with service contribution and match savings

Qualifications

Required

• 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.

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

• Optional identity theft protection, home and auto insurance, pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

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CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.