Manager, Home Health Program Integrity

POSITION SUMMARY:

Manages the day-to-day evaluation of clinical documentation of BAYADA's Home Health Care practice for both accuracy and compliance. Assists the Director of Home Health Program Integrity with policy development, audit management, and educational programming development. Relies on extensive home health and/or outpatient experience and judgment to plan and accomplish goals and acts as a guide to service offices in their requirement to internal policies and external regulatory demands and guidelines.

MINIMUM QUALIFICATIONS:

• Exemplifies characteristics of The BAYADA Way: compassion, excellence and reliability.
• Four (4) year college degree.
• Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist with at least five (5) years of home health and/or outpatient experience.
• Prior experience in documentation review, home health auditing, outpatient documentation review, or appeal writing is preferable.
• Three (3) years of home health compliance, leadership, and clinical documentation in home health and outpatient therapy experience desired.
• Strong knowledge of home health and outpatient industry standards, rules and regulations, Medicare Conditions of Participation, and requirements.
• Ability to work independently, motivate and be self-motivated, flexible, versatile, and creative.
• Possess problem solving and leadership skills and be able to foster interpersonal relationships.
• Must have the ability to write reports, business correspondence, and procedure manuals and the ability to effectively present information and respond to questions from groups of employees, managers, directors, and clients.
• Able to solve practical problems and deal with a variety of concrete variables in situations where some standardization exists.
• Must have strong attention to detail, be well organized, and perform multiple tasks concurrently.
• A wide degree of creativity, initiative, and problem-solving is expected.
• Must be proficient in Microsoft Excel, Word, PowerPoint.
• Ability to read, write and effectively communicate in English.
  
  
  

PRIMARY RESPONSIBILITIES:

• Demonstrate and communicate the core values of BAYADA and The BAYADA Way.
• Develop working knowledge of BAYADA’s mission, services, people, organization, policies and procedures.
• Participate in the development of company policies and procedures to better serve our clients.
• Continuously review and recommend revisions to company operating systems to ensure they are current, efficient, effective, and reliable.
• Actively participate in companywide projects and initiatives as needed.
• Monitor Medicare Administrative Contractors and Medical Review contractor websites for Medical Review activities and the receipt of Additional Documentation Requests (ADRs).
• Conduct pre and post-payment reviews of ADR records, analyze and communicate results, as applicable.
• Ensure the accuracy of audit data and engage in trend analysis of audit data in collaboration with the supervisor.
• Provide documentation recommendations to office directors to educate staff regarding documentation requirements of regulatory agencies and payors.
• Educate service offices on external Medical Review activities and results and the correlating internal support processes.
• Conduct reviews of denied claims and draft appeals as indicated in collaboration with service office leadership.
• Participate in Administrative Law Judge hearings, as necessary.
• Research industry trends/reports, such as those from the Office of Inspector General (OIG), the Centers for Medicare and Medicaid Services (CMS), etc.; stay current regarding compliance risk issues in the industry; understand their potential impact on BAYADA and recommend program enhancements as appropriate.
• Act as a home health & outpatient clinical documentation expert. Provide insight and guidance to the Home Health practice.
• Support Quality Assurance and Performance Improvement (QAPI) team efforts related to clinical documentation projects, as necessary.
• Liaison with other offices and coordinate their activities as directed by the supervisor.
• Maintain a working knowledge of relevant regulations, laws, accreditation standards, policies, and industry trends and understand their potential impact on BAYADA.
• Identify personal learning needs and address them by actively pursuing opportunities to expand knowledge and skillset.
• Manage workload and adhere to deadlines while providing exceptional customer service to service/support office personnel.
• Demonstrate solid performance or exceed performance standards in key job dimensions/attributes as defined on the Performance Appraisal for Office Staff.
• Perform related duties, or as required or requested by supervisor.
  
  
  

As an accredited, regulated, certified, and licensed home health care provider, BAYADA complies with all state/local mandates.

BAYADA is celebrating 50 years of compassion, excellence, and reliability. Learn more about our 50th anniversary celebration and how you can join in here.

BAYADA Home Health Care, Inc., and its associated entities and joint venture partners, are Equal Opportunity Employers. All employment decisions are made on a non-discriminatory basis without regard to sex, race, color, age, disability, pregnancy or maternity, sexual orientation, gender identity, citizenship status, military status, or any other similarly protected status in accordance with federal, state and local laws. Hence, we strongly encourage applications from people with these identities or who are members of other marginalized communities.