CenterWell Senior Primary Care

Compensation

Full Description

Job Description: • provides leadership for the audit, appeal and review process to preserve and recover revenue while maintaining the highest level of clinical and regulatory integrity and compliance • manages the Denials Management data analytics, denial and appeal process • assists members, via phone or face to face, further/support quality related goals • investigates and resolves member and practitioner issues • oversees the process for direction and support to clinical and operational leadership regarding Medicare and governmental audit trends, denials, and any CMS initiative and/or demonstration projects • collaborates with leadership team in the development of an education plan to improve processes to preserve and recover revenue • analyzes region-wide outcome indicators to measure achievement of quantitative and qualitative standards • maintains region-wide Performance Improvement program which includes Customer Satisfaction, complaints, infection monitoring, Incident Reporting, and quarterly branch PI activity • communicates with Corporate leadership, Regional and Divisional leaders as appropriate to resolve issues that may place patients or the company at risk • oversees educational in-services based on analysis of PI data and activities • acts as a resource for the Operations Support team and communicates Performance Improvement results • participates in special projects and performs other duties as assigned Requirements: • Bachelor's degree in Nursing or related field • 10-15 years progressively responsible experience in home health or hospice industry that includes performance improvement and outcomes measurement • 5 years’ experience in a supervisory or teaching role • Thorough knowledge of health care policy, industry and related clinical practice • Knowledge in the interpretation and application of regulations and performance improvement standards • Strong Project management principles and clinical policy development/implementation required • Expert knowledge of all Medicare regulations and appeals processes • Excellent analytical skills with ability to interpret and apply regulatory requirements • Excellent verbal/written communication and presentation skills • Advanced knowledge with Payer requirements, ADR requests, Denials, Appeals, RAC/ZPIC and CERT responses • Must be able to work well independently and in a team environment • Excellent communication and organization skills • Strong attention to detail • Healthcare industry experience preferred • Must read, write and speak fluent English • Must have good and regular attendance Benefits: • medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave) • short-term and long-term disability • life insurance • many other opportunities