This role utilizes specialty knowledge regarding Inpatient Rehabilitation Facility reimbursement and regulations to advance the education of faculty and staff, ensure facility compliance with regulatory standards, maximize reimbursement and oversee quality initiatives especially related to clinical documentation. This individual must be able to functionally supervise, review and cover for the PPS Coordinator and transmitting claims to CMS. The candidate must have excellent clinical knowledge and be able to create and present to Faculty, Residents, Nurses, Therapists and Administration on regulations and goals in a way that is clear, compelling, motivating and supportive of each discipline. Monitors compliance with the quality and payment regulations.
Provides functional supervision to PPS Coordinator(s) in completing IRF-PAI. Makes sure timely and accurate submission of IRF-PAI occurs and is the back-up and reviewer for transmission to Medicare.
Tracks compliance with 60% rule and provides analysis and identification of factors impacting compliant diagnoses
Completes routine accuracy and quality audits to ensure complete and accurate IRF-PAI data that is supported by clinical documentation.
Leads efforts to streamline data abstraction process related to completion of the IRF-PAI including working toward interface between EMR and inpatient rehab facility outcomes system.
Works with EPIC to address changes/updates necessary to maintain alignment with IRF reporting and documentation requirements.
Maintains updated and ongoing knowledge of federal regulations concerning the IRF PPS and IRF-PAI to ensure compliance with all regulations, collaborates with discipline leaders to create and establish compliance plans.
Delivers or oversees delivery of IRF PPS education on FIM, QI, Medicare guidelines, and documentation requirements to Clinical Team and reports on adherence and issues to rehab management team
Development of FIM competency requirement
Oversight of FIM credentialing process
Physician documentation requirements
Completes medical record reviews, including data collection, content review, and reporting. Provides education on documentation requirements as defined by Medicare and TJC
Maintains current knowledge of IRF operational metrics, provides monthly status reports to IRF administrative and clinical leaders.
Develops and maintains IRF Dashboard and benchmarking data
Reviews annual PEPPER report and plans for and oversees the execution of risk mitigation strategies as needed in partnership with interdisciplinary leaders
Communicates with Infections Control Department to ensure timely submission to NHSN. Assists with coordination of the Infection Control Program to ensure program compliance with all regulatory and accrediting standards
Reports on adherence and issues to administration team.
Monitors and provides assistance with planning of quality assurance and compliance functions and ensures relevant policies and procedures are monitored and updated to include regulatory changes.
Collects and analyzes data to support Peer Review, physician profiling, quality assurance, and performance improvement activities.
In partnership with Compliance and IRF leadership, develops and assists with implementation of process-improvement and risk mitigation projects and initiatives to ensure compliance with current CMS regulations.
Partners with Compliance and Revenue Cycle for development and implementation of internal audits to ensure ongoing compliance with regulations.
Provides input and representation on key compliance and quality initiatives, QA meetings and committees.
Collaborates in the development of audit reports that assess appropriateness of currently established protocols and developed corrective action plans.
Reports IRF leadership on any adherence and compliance issues
Investigates quality and risk issues with regard to patient occurrence reports, complaint and/or quality related cases.
Supports disease specific and other certifications.
Maintains collaborative relationships with key partners in HIM, Revenue Cycle and other areas.
Acts as liaison with Billing department regarding IRF PPS reimbursement, ADRs and possible patterns of documentation or admission practices impacting reimbursement and/or compliance
Oversees/ acts as liaison between HIM and PM&R Partnership to elevate partnership to that of Best Practices Model
Minimum of a bachelor's degree in a recognized field which is directly related to the duties of the position and at least 5-8 years experience in analyzing and interpreting process, clinical outcomes and cost of care
Experience interpreting complex compliance regulations, analyzing and interpreting data, and teaching/presenting regulatory requirements
Knowledge of patient care delivery in hospital setting
Experience in conducting documentation audits
Ability to work independently, self-motivated and an ability to adapt to the changing healthcare environment.
Proficiency in organizational skills and planning with an ability to juggle multiple priorities in a fast changing environment.
Proficiency in database and spreadsheet creation and analysis, (Excel) and presentation software
Ability to navigate the electronic health record (EHR) to identify documents for review to provide accurate capture of clinical information
Must be detail oriented with strong analytic and problem solving skills, exceptional communication skills (both verbal and written) as well as exceptional presentation skills
Master’s degree in a recognized field which is directly related to the duties of the position
Experience using UMHHC information systems/applications (MICHART)
Experience as a Clinical Documentation Specialist
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act.
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Job openings are posted for a minimum of seven calendar days. This job may be removed from posting boards and filled anytime after the minimum posting period has ended.
U-M EEO/AA Statement
The University of Michigan is an equal opportunity/affirmative action employer.