Documentation
a. Communicates and coaches all BHU treatment team members (physicians, case managers, nursing, and therapy) to ensure accurate, complete, and timely documentation of medical psychiatric status to meet regulatory guidelines and timelines.
b. Maintains awareness of CMS requirements regarding medical necessity and is responsible for communication with the Utilization Management department to ensure information necessary for concurrent reviews is accurate and present.
c. Completes daily audits of BHU team documentation to ensure CMS/TJC compliance and accuracy with all preadmissions, post admission, Psychiatric Evaluation, History & Physical, and patient evaluations.
d. Attends Treatment Team and ensures daily documentation of all team members for all patients.

Financial Coordination
a. Ensures that pre-certifications and/or re-certifications for treatment are completed as required.
b. Work to help decrease/overturn denials by ensuring correct demographics/patient insurance information has been registered and providing additional documentation as needed.
c. Handle internal and external inquiries about insurance and general financial counseling.
d. Verify documentation and physician order that supports medical necessity for hospitalization.
e. Works closely with PAS to ensure accurate registration and preauthorization of patients.
f. Reviews admission diagnosis code and documented comorbidities and ensures complete and timely documentation exists to support accurate reimbursement.
g. Provides ongoing education to all staff regarding appropriate documentation.
h. Responsible for completion and presentation of the monthly metrics report to the BHU Medical Director and leadership for review and generation of action planning for performance improvement as appropriate.
i. Responsible for coordination of the optimization of EPIC to ensure CMS compliance and quality reporting.

Clinical /Regulatory
a. Stays current on all CMS updates related to inpatient behavioral health treatment.
b. Responsible for psychiatric providers, nursing, and therapy services clinical documentation competencies.
c. Maintains awareness of requirements regarding medical necessity to facilitate communication and education of all team members.
d. Reviews psychiatrist, therapy, and nursing documentation to ensure medical necessity is accurately reflected.
e. Develops action plans to address outcomes performance goals for meeting/exceeding national outcomes.
f. Completes ongoing audits of BHU team documentation to ensure CMS compliance with all Pre-admission, Post- admission Physician Evaluation, evaluations, Plan of Care, team conference notes and daily provider, therapy, and nursing documentation.
g. Responsible for implementation of newly released regulatory policies and procedures from CMS, fiscal intermediary, or other regulatory bodies.

Patient Assistance
a. Oversees patient assistance programs as needed including co-pay assistance programs, and other programs that assist patients with paying for their medications.
b. Coordinate with departments that handle reimbursement, denials, and authorizations.
c. Works closely with the Social Workers in reviewing the patient’s financial needs.
d. Completes prior authorizations for medications post discharge as needed.
e. Completes monthly data outcomes report for the BHU Medical Director, BHU leadership and staff review.

Customer Service
a. Serves as the liaison for the BHU to any regulatory bodies for purposes of outcome tracking and compliance.
b. Maintains ongoing communication to all stakeholders the opportunities to improve documentation based on results of chart audit.
c. . Maintains professional code of conduct, dress, and behavior during the performance of duties.