Prospective Payment & Revenue Management Specialist

Prospective Payment & Revenue Management Specialist

We have the great privilege of helping patients and families re-build their lives. It’s extraordinarily meaningful work and the reason we greet the day with optimism and anticipation. When patients “Ask for Mary,” they experience a culture that has been sculpted for more than a century. Our hallmark is to carefully listen to patients and innovatively serve them. This is true of every employee, from support staff and leadership to clinicians and care providers.

Mary Free Bed is a not-for-profit, nationally accredited rehabilitation hospital serving thousands of children and adults each year through inpatient, outpatient, sub-acute rehabilitation, orthotics and prosthetics and home and community programs. With the most comprehensive rehabilitation services in Michigan and an exclusive focus on rehabilitation, Mary Free Bed providers, nurses and therapists help our patients achieve outstanding clinical outcomes. The growing Mary Free Bed Network provides patients throughout the state with access to our unique standard of care.

Mission Statement                                                                                                                           

Restoring hope and freedom through rehabilitation.

Employment Value Proposition     

At Mary Free Bed, we take pride in our values-based culture:

• Focus on Patient Care. A selfless drive to serve and heal connects all MFB employees.
• Clinical Variety and Challenge. An inter-disciplinary approach and a top team of professionals create ever-changing opportunities and activities.
• Family Culture. We offer the stability of a large organization while nurturing the family/team atmosphere of a small organization.
• Trust in Each Other. Each employee knows that co-workers can be trusted to make the right decision for our family, patients, staff, and community.
• A Proud Tradition. Years of dedicated quality service to our patients and community have yielded a reputation that fills our employees with pride. 

Summary                                                                                                                                          

The Prospective Payment & Revenue Management Specialist is responsible for developing, implementing, and supporting organizational processes that ensure compliance with CMS regulatory standards related to documentation and coding requirements. This specialist partners closely with the system leadership & PPS Coordinator at each location to lead and manage the claim and post-payment denial process.

Key responsibilities include maintaining a strong understanding of compliance and regulatory requirements, conducting documentation audits, identifying and driving process improvement, and providing PPS-related support across the organization. The specialist will collaborate with revenue cycle departments and insurance companies to supply additional documentation as needed and prepare or support appeals for denied claims.

The PPS Denial Management Specialist is expected to achieve and maintain an effective and harmonious relationship with team members and providers throughout the system. The role involves regular on‑site presence to support payment denial operations, collaborate with local teams, and ensure consistent implementation of organizational standards across the entire multi‑state system.

Essential Job Responsibilities                                                                   

• The PPS Denial Management Specialist will lead the development of a coordinated approach to claim and post-payment denial communication and system site support. Working in conjunction with the Manager of Regulatory and PPS Compliance, program leaders, providers, PPS staff and acute billing teams across the system, the specialist will facilitate sharing of best practices and standards of communication around claim and post-payment denial management.
• Professional Work Environment - Encourage a culture of personal accountability, solution-seeking behavior, mutual respect, open communication, openness to change, enthusiasm, and pride.
• Function as subject matter expert to management as directed in the following areas:
  • IRF-PPS reimbursement issues/appeals
  • IRF-PPS regulatory changes
  • IRF-PPS compliance
  • Revenue collection process
  • Insurance contract and authorization process
• Support the system sites with insurance denials and/or requests for additional information (ADR responses, post-payment denials and medical records templates) in a timely manner.
• Assist in the development and implementation of workflows related to claim and post-payment denial handling to improve process efficiency and compliance.
• Audit and review clinical documentation, coding, claims and scoring, to ensure payer and governmental agency regulatory and compliance requirements are consistently followed and applied.
• Ensure adherence to all HIPAA and regulatory requirements when managing payment claims, denials and protected health information.
• Track all claim and post-payment denials across the Mary Free Bed system within a database for reporting.
• Maintain appropriate established timelines for follow up on outstanding appeal/reconsideration requests. Coordinate with internal departments and external representatives to ensure accurate information sharing and prompt follow-up on outstanding issues.
• Develop standards and procedures through collaboration, development, implementation and evaluation of goals and objectives, policies and procedures, and operating parameters related to Revenue Cycle compliance. In a timely fashion, assist with updating and distributing applicable policy and procedures with current compliance information, along with notification and/or training on the effect or implication of such policy or procedure on the Revenue Cycle department.
• Collaborate with other Revenue Cycle Management and clinical departments to resolve claim issues as needed.
• Additional Responsibilities – As determined by the VP of System Operations, with guidance from the Manager of Regulatory and PPS Compliance, the leadership teams from Mary Free Bed and the company system locations. It requires frequent travel to all sites across the entire multi‑state system.

Leadership Must-Haves will be followed for patient and staff interactions:

• We’ll embrace all people by:
  • Treating everyone with dignity and respect.
  • Opening more doors to opportunity for others to succeed.
  • Growing talent and people.
  • Ensuring a welcoming experience for all we serve, regardless of origin, race, religion, disability, sexual orientation or socioeconomic status.
  • Taking action against discrimination.
  • Honoring our differences and how we collaborate.
  • Educating staff, patients and the communities we care for.
  • Restoring hope and freedom, together.
• Rounding
• Thank You Notes
• Employee Selection/Peer Interviewing
• Key Words at Key Times
• AIDET® + Promise
• Standards of Behavior

Customer Service Responsibilities                                                                                         

Demonstrate excellent customer service and standards of behaviors as well as encourages, coaches, and monitors the same in team members. This individual should consistently promote teamwork and direct communication with co-workers and deal discreetly and sensitively with confidential information.

Responsibilities in Quality Improvement                                                                                

Contribute by identifying problems and seeking solutions. Promote patient/family satisfaction where possible; participate in departmental efforts to monitor and report on customer service.

Essential Job Qualifications                                                                                                   

• Education: Associate’s Degree or higher required.
• Licensure (Preferred, Not Required): Active licensure as a Registered Nurse (RN), Physical Therapist (PT), Occupational Therapist (OT), or Speech-Language Pathologist (SLP).

• Strong consideration for experience in the Inpatient Rehabilitation Facility Prospective Payment Systems, revenue cycle, Health Information Management or coding, with exposure to CMS regulatory concerns.
• Ability to travel frequently to all system locations across the entire multi‑state system.
• Accurate decision-making and strong interpersonal communication skills.
• Information management skills and ability to interpret, communicate, and present data. Demonstrated excellent written and verbal communication skills.
• Demonstrated ability to work both independently and in conjunction with a team of professionals for problem solving.
• Sense of urgency, collaborative team style, and ability to quickly adapt to changes in priorities.
• Ability to multi-task and delegate tasks for timely project completion.
• Demonstrated commitment to organizational mission with a “whatever it takes” attitude to get the job done.
• Excellent organizational skills

Physical Requirements for Essential Job Qualification

Levels:

• None (No specific requirements)
• Occasionally (Less than 1/3)
• Frequently (1/3 to 2/3)
• Majority (More than 2/3)

Remain in a stationary position: Frequently

Traverse or move around work location: Occasionally

Use keyboard:  Majority

Operate or use department specific equipment:  None

Ascend/Descend equipment or ladder: None

Position self to accomplish the Essential Functions of the role: Occasionally

Receive and communicate information and ideas for understanding: Majority

Transport, position, and/or exert force:

Up to 10 pounds:   Occasionally

Up to 25 pounds: Occasionally

Up to 50 pounds: None

Up to 75 pounds:  None

More than 100 pounds: None

Other weight: Up to___ pounds  _____

       Other:  _____

Consistent with the Americans with Disabilities Act (ADA), it is the policy of Mary Free Bed Rehabilitation Hospital to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Talent Acquisition team at recruitment@maryfreebed.com.

Mary Free Bed is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, genetic information, veteran status, disability or other legally protected characteristic.