Rehabilitation Regulatory Coordinator Lake Main Campus

The Rehabilitation Regulatory Coordinator is responsible for improving the overall accuracy and completeness of required documentation for the inpatient rehabilitation program. This position runs audits on the Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF - PAI). Requests clarification from clinicians and/or leadership on documentation that is incomplete and in question from a medical chart review. Facilitates modifications to the IRF PAI based on documentation to create an accurate reflection of the rehab stay capturing the rehab diagnoses active comorbidities and quality indicators that have been addressed during the inpatient rehab stay. Maintains accurate and complete medical record reviews that follow the regulatory standard guidelines. Identifies opportunities for staff development based on trends of clinical documentation practice. Participates in ongoing education to enhance professional development and stays current with rules and regulations from Centers for Medicare and Medicaid CMS and other regulatory bodies.

• Coordinates the data collection for the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF - PAI) according to the designated standards and time frames as set by CMS. The regulated time frames are educated and practiced amongst the interdisciplinary team. Manages data completeness throughout the rehab stay by reviewing and ultimately providing approval for each patient cases.
• Responsible to stay current with rehab program census activity and status; works with the clinical team on admissions and discharges queries.
• Collaborates with admission team on managing appropriate Impairment Group Codes Etiologic Diagnoses and comorbidities that are needed to reach medical compliance and maximum reimbursement. Serves as an educational resource to guide the liaisons in the assessment report as needed.
• Guides the clinical team on compliance coding and provides instruction on coding standards from resources such as Appendix A Centers for Medicare and Medicaid resources and ICD- 10 guidelines.
• Demonstrates the ability to interpret the medical record documentation to determine appropriate medical summary as referenced in the IRF PAI.
• Consults with leadership and clinical disciplines in matters of uncertainty.
• Collaborates with leadership and Epic analysts on reporting structures for IRF PAI management. Project improvements will be monitored and tracked with supportive resources for the goal of designing efficient and effective EMR pathways.
• Consults with the Director on cases involving denials and/or managing justification to appeal responses. Provides feedback on ongoing trends and rationale for denials while providing corrective actions with staff continually improving Epic functionality and aides in any educational updates.
• Integrates a communication plan with the director for any related changes / updates to program practice changes and regulatory requirements.
• Consults with Health Information Manager (HIM) Patient Access and Revenue Integrity teams to prepare for appropriate coding and encounter management. Pursues reimbursement opportunities. Serves as a Liaison between HIM personnel and Patient Access to ensure appropriate coding documentation for the delivery of services.
• Responsible for collecting the initial data elements to determine the estimated length of stay for the weekly interdisciplinary team conference meetings. By providing the Case Mix Group (CMG) this will assist the team in having an estimated length of stay and consideration for the management of services needed.
• Initiates clear and concise communication with the medical providers providing updates via emails in person communication telephone messages. Submission queries to the physicians are sent to seek clarity on diagnoses procedures complication comorbidities as indicated to capture the most comprehensive justification for medical treatment and services provided during the rehab stay.
• Consults with the program Director and/or Medical Director on any regulatory concerns that have been identified regarding program improvement.
• Conducts medical record audits to ensure completeness of medical record status.
• Educates and trains staff including physician nurses therapists and case managers on documenting requirements and standards for inpatient rehab to ensure the supportive documentation reflects the need for intensity of services provided medical necessity of the services provided and the need for 24-hour nursing.
• Responsible for strong working knowledge of payor influence and reimbursement methodology. Analyzes documentation and coding to maximize reimbursement from all payors. Utilizes multiple resources for accuracy of coding: UDS CMS Benefit Manual and Federal Register resources Appendix A and others.
• Responsible for current knowledge of regulations and requirements of Medicare Medicaid and other licensing boards. Collaborates with Director to facilitate compliance with regulatory standards and coordinates audits related to Rehab revenue management.
• Conducts ongoing chart audits to ensure accuracy and consistency of documentation according to the CMS standards of care for inpatient rehabilitation. Tasks must be organized and managed according to timely documentation to avoid reasons for denials.
• Tracks and reports rehab compliance according to CMS guidelines via Epic resources and UDSMR software. Reviews documentation for consistency and completeness according to the rules and regulations. Seeks clarification from regulatory bodies when any elements are in question.
• Maintains oversight of overall data collection for IRF PAI with the presence of supportive documentation and exercises close partnership with the interdisciplinary team (physicians nurses therapists (PTOTST) case managers liaisons and administrative personnel). Collaborates with all parties involved in IRF PAI submissions and manages any deficiencies or notifications in reporting.
• Assists leadership in the management of denials and appeals at all levels by working to defend cases with supportive medical findings. Participates and collaborates with denial analysts.
• Collaborates with Epic Analysts to trouble shoot challenges with IRF PAI findings and develops solutions for IRF PAI compliance and efficiency according to the CMS guidelines. Attends team meetings to optimize Epic documentation for FMOLHS to best suit the clinical teams workflow and meet the standards for an Inpatient Rehab Facility.
• Attends webinars on regulatory updates any final ruling from CMS or educational topics that would benefit operations in compliance or regulatory compliance. Works with leadership to prepare for future planning and preparation for any teams affected.
• Serves as an information resources to other departments including other inpatient rehab programs affiliated FMOLHS.

Experience: 3-4 Years of experience needed; Inpatient Rehab experience preferred

Education: Bachelors Degree Preferred

Knowledge/Skills: Attention to Detail Strategic Thinking Effective Communication

Certification/Licensure: Valid License required issued by governing body for any of the following:

1. Louisiana State Registered Nurse License
2. Louisiana State Physical Therapy License
3. Louisiana State Occupational Therapy License
4. Louisiana State Speech Language Pathology License
5. Louisiana State Licensed Clinical Social Worker