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AVP Of Clinical Reimbursement Job Details

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Company:  Gentiva
Job Code:  22544646
Categories:  Home Healthcare / Home Care
Job Role:  Administrator
Job Type:  Full Time
Preferred Degree:  Bachelors
Experience Required:  10 years
Salary:  Competitive
Country:  United States
Region/Province:  Georgia (GA)
City:  Atlanta
Job Description: 

I believe that better care begins at home.

Compassionate care, uncompromising service and clinical excellence - that's what Gentiva® patients have come to expect from our clinicians for nearly 40 years. Gentiva, America's homecare leader, has set the clinical standard for today's fastest-growing segment of healthcare - homecare. By creating innovative solutions that lead to high-quality patient outcomes, Gentiva's patient-centered approach improves quality of life and independence.  With Gentiva, great healthcare has come home.

 

 

I believe I can make a difference.

With almost 40 years of experience and more than 380 locations in 39 states, Gentiva serves approximately half a million patients annually. Gentiva is a company on the move - driving some of the most exciting new opportunities in home healthcare. Financially and strategically, we are positioned to be a key player in the industry for years to come. All of which make Gentiva the place to be.

 

 

I believe in working for a company that cares as much as I do.

 

Gentiva offers a unique employment package that includes:

*         Unprecedented opportunities for career growth

*         Working in an environment where you are supported by a team of skilled healthcare professionals who are committed to providing the highest level of care where the patient comes first

*         Competitive salary

*         Comprehensive benefits which include competitive pay with direct deposit, medical, dental, vision, short and long term disability, life insurance, a generous PTO package, paid holidays, 401(k), tuition reimbursement and much more

I believe that a stronger team begins with me.


Area Vice President of Clinical Reimbursement:
  • Responsible for the Medicare/Medicaid reimbursement process evaluation and training of staff and admissions liaisons to increase knowledge & skills and optimize revenue under each program.
  • Oversees clinical peer utilization review in collaborative communication style using standardized review tools.
  • Identifies areas of process improvement which affects both revenue cycle outcomes and patient satisfaction. Researches problematic areas in order to involve a team approach and determination of actual issue. Works with all involved departmental areas to determine root cause of issue and appropriate actions plans.
  • Facilitates the implementation of the action plans and formation of any appeal process.
  • Monitors the improved process outcomes and works closely with the Regional Outcomes and Analytics and Performance Improvement team members in the assessment of the process. Reactivates the Regional team if further improvement is needed.
  • Works closely with the administrative teams at the branch/regional levels to share opportunities and action plans.
  • Coordinates all activities with the Revenue Cycle Team for appropriate follow-up. Enters any pertinent data as indicated and directed.
  • Implement and direct Medicare and Medicaid auditing and systems review.
  • Reviews clinical denials to ascertain appropriate allocation and identification.  Works with the Revenue Cycle departed to appropriately record as indicated.
  • Facilitate the appeal process by working with the impacted branch/region. Assists in the appeal process as indicated, assuring the appeal is forwarded to the payor and business office.
  • Follows up on appeal status and documents. Notifies business office of outcome to facilitate collections of revenue due.
  • Reports as required on appeal process to both Revenue cycle and branch operations.
  • Serves as continual resource to branch/region for prevention of future denials.
  • Responsible for clinical documentation assessment and coding management
  • Update branches on trends, developments, concepts and best practice to ensure compliance in the Medicaid and Medicare fields that affect reimbursement services.
  • Engage branch management in problem solving process to identify improvement opportunities and achieve solution.
  • Facilitate effective well-organized utilization meetings, establish productive objectives and follow through with action plans.
  • Partners with Regional and Branch leadership to evaluate performance of branch clinical staff and make recommendations regarding staff assignments, assessment procedure and reimbursement systems.
  • Partners with Divisional, Regional, and Branch leadership to provide financial analysis, rate projections, monthly key factor report distributions, and assistance in the budget process.
  • Partners with Regional and Branch leadership to provide ADR process management and support.
  • Collaborates with billing and finance to ensure timely billing and best in practice for managing DSO.
  • Analyzes and interprets data to facilitate opportunities within the branch case management/quality departments. Works in collaboration with branch and regional leadership to improve overall patient outcomes.
  • Gathers and organizes data for quality improvement, staff and physician education.
  • Collaborates with the Revenue Cycle team and case management/quality teams to improve overall outcomes.
  • Presents research as indicated to the Divisional, Regional and Branch Home Healthcare Administrative teams to facilitate implementation of action plans to improve clinical and financial outcomes.
Qualifications
  • Masters degree in Business, Nursing, or related health field preferred with minimum of an RN, PT, or OT current license required.
  • Must possess strong analytical skills. Excellent oral and written communication skills required and be able to communicate at all levels. The individual has the ability to deal with diverse issues and be comfortable presenting to small and large groups.
  • Must have practical knowledge of common office software applications including Power Point, Excel, Word, coding/billing software, EMR, etc... 
  • Utilization Review/Case Management experience preferred.
  • Demonstrate critical thinking and problem solving abilities.
  • Detailed understanding of the third party and CMS healthcare policy-setting authorities, processes, and responsible parties. Consultative/participative leadership style is required.
  • The ideal candidate is results-oriented, enthusiastic and self-motivated. Action oriented, driven and high integrity person with willingness to 'roll up their sleeves' and to 'think and operate outside of the box', must have demonstrated ability to develop people and build teams.
  • Strong strategic orientation and is capable of directing clients at the highest levels of the organizations we work with.
  • Licensed Clinician with bachelor degree minimum, plus a minimum of eight years clinical nursing experience including three years of professional clinical practice management, preferred.

I believe the best is yet to come.

As an associate, we give you everything you need to make the most of your career, including advanced education and training, the latest resources and the industry's highest standards of clinical excellence. When you work for Gentiva Home Health, you can expect more: more opportunities, more challenges, more rewards. That's why Gentiva is the employer of choice for some of today's most experienced and talented associates.

*Gentiva Health Services, Inc. is an Affirmative Action/Equal Opportunity Employer M/F/D/V encouraged to apply.

Post Date:  01/12/2012

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