GENESIS HEALTHCARE SYSTEM

In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis HealthCare System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an 'owner' of Genesis and keep our patients at the center of everything we do - always.

Position Details:

Work Shift:
Day Shift (United States of America)

Scheduled Weekly Hours:
24

Department:
Patient Account Management

Overview of Position:

To lead and facilitate strategic aspects of all denials including all initiatives associated with Recovery Audit Contractors (RAC) implementation at Genesis HealthCare System. Monitors overall impact of denials and RAC effect by developing workflows, policies and procedures, and a communication plan to prepare for RAC audits. Manages RAC requests for records, appeals, and revenue adjustments through a tracking system database.
ESSENTIAL DUTIES
1. Directs, plans, coordinates and oversees specific functions and activities associated with all denials including the RAC audit process.
2. Writes all level appeal letters, making a case for additional reimbursement.
3. Oversees the maintenance of the denials and RAC database to assure accurate information is documented.
4. Assists in the development of RAC policies and procedures approved by the Revenue Cycle Steering Committee.
5. Functions as the primary RAC liaison for case management, physicians, documentation improvement specialist, clinical and operational departments and patient accounting.
6. Recommends process or policy changes as necessary to avoid lost revenue as a result of denials/RAC requests/audits.
7. Analyzes and prepares monthly reports documenting the status of all request/audits and submits to RAC Team members.
8. Performs final review of records being submitted to the RACs and tracks the appeal process and outcomes for RAC audits.
9. Researches and maintains regulatory guidelines applicable to coding/medical necessity as needed for defense purposes relative to the RAC audits.
10. Works directly with physician advisor to educate physicians on utilization, medical necessity, and documentation improvement.

QUALIFICATIONS
1. Registered Nurse.
2. 3 years in an acute care setting, utilization management, or insurance/hospital case management setting.
3. Knowledge of InterQual criteria.
4. Attends an educational program on Hospital Based Coding Guidelines within the 1 year.
5. Demonstrated knowledge of CPT-HCPCS, modifiers, UB revenue codes, ICD-9-CM diagnosis and procedure coding and Medicare guidelines.
6. Excellent written and oral skills, attention to detail and follow through.
7. Ability to organize work, recognize and establish priorities, and complete work without creating backlogs.
8. Excellent interpersonal, decision-making, facilitation, conflict resolution and investigative skills.
9. Excellent computer skills and knowledge of computer software, including Word, Excel, PowerPoint, etc.
10. Ability to work independently and under pressure in a complex and changing working environment.

PATIENT CENTERED CARE & BEHAVIORAL EXPECTATIONS
1. Living the Genesis Mission, Vision and Values
• Performs work in a manner that is quality focused.
• Treats patients, co-workers, visitors and volunteers with courtesy, compassion, empathy and respect.
• Results oriented and focused on achievement of objectives.
• Acknowledges and responds to the diversity of people and the situation.
• Encourages peers (others) to be owners of change.
• Always makes the effort to anticipate and exceed customer needs and expectations.
• Possesses the ability to engage others with patience and understanding.
• Acts in a manner that creates positive first and lasting impressions.
• Demonstrates the ability to own issues until they are resolved.
2. Patient Centered Care (patients/families, physicians, co-workers, all other internal/external customers)
• Introduces self and role...connects with everyone.
• Communicates effectively (i.e. advising others of actions, pertinent information, time durations, etc.) and asks for feedback.
• Asks for and anticipates needs and concerns of others.
• Maintains a positive work environment for staff and a healing environment for patients (i.e. safe, clean, quiet, etc.)
• Maintains the dignity and privacy of each person; manages confidential/sensitive information appropriately.
• Responds to requests in an appropriate and timely manner.
• Exits patient/customer encounters courteously, asking if there are additional needs that can be addressed.
3. Promotes Patient and Employee Safety
• Demonstrates safe Patient Handling (i.e. transfers, transport, care administration, nutrition, medication, etc.)
• Demonstrates safe Materials Handling (i.e. appropriate use and disposal of chemicals, infectious wastes, etc.)
• Demonstrates appropriate knowledge of Infectious Disease precautions and use of proper protective equipment
• Demonstrates Slips/Trips and Falls Awareness.
• Actively contributes to maintaining a safe, clean and quiet environment.

WORKING CONDITIONS/PHYSICAL REQUIREMENTS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential function of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Works mainly in an office environment.
2. Will travel to other locations and floors. Answer telephone calls, uses personal computer and other business machines extensively, which requires the ability to apply finger dexterity. Bends, reaches, pushes and pulls as necessary to file records and reports.
3. Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds.
4. Vision abilities required include up close vision, peripheral vision, depth perception and the ability to adjust focus.
5. Must be able to work extra hours as required.

This description reflects in general terms the type and level of work performed. It is not intended to be all-inclusive, nor portray the specific duties of any one incumbent.

Thank you for your interest in employment at Genesis. Genesis is committed to being an equal opportunity employer. Selection of applicants for employment is based only on qualifications and the requirements of a specific job.