Rehab Operations Manager Newton, MA About Us Five Star Senior Living, a national healthcare and senior living provider headquartered in Newton, Massachusetts, proudly offers the highest quality service and care with the warmth and hospitality of home. Founded in 2000, Five Star has two major operating divisions: Five Star Senior Living and Five Star Rehabilitation Services. The Five Star Senior Living division includes more than 260 senior living communities across the United States and is one of the country's largest providers of quality retirement living in the nation offering Independent Living, Assisted Living, Alzheimer's/Memory Care, Healthcare Centers with Skilled Nursing & Rehabilitation and Continuing Care Retirement Communities. Five Star Rehabilitation Services include outpatient rehabilitation, day programs, and respite/short stay options. Location Information: Five Star Senior Living's corporate headquarters are located in Newton, Massachusetts. Just 20 minutes outside of downtown Boston, the building features easy access to public transportation and the Massachusetts Turnpike. Key Responsibilities This position works closely with the VP of Operations to evaluate, enhance, grow and maintain operational performance in the inpatient clinics, outpatient clinics and home health contracts. In addition this position will oversee Medicare B appeals, audits, and regulatory issues related to Rehabilitation services. • Monitors, analyzes and trends data for outpatient clinics and identifies opportunities to improve clinical and financial performance • Works collaboratively with team to identify and support new clinic startups. • Works with VP and Financial analyst on identifying operational and financial opportunities and develops plans for improvement. • Performs due diligence to assess future business growth opportunities. • Works with business office, clinical and financial analyst on month end close activities. • Serves as a technical resource for the rehab software applications. • Works collaboratively with the Rehab Clinical Manager with respect to planning, implementation, training and oversight of rehab software applications • Manages the rehab software financial and Medicare reports, • Maintains focus on increasing Med B, Home Health, and Managed Care growth • Supports the growth of wellness and personal fitness program • Interprets and distributes regulatory transmittals, guidances, NCDs and intermediary LCDs and updates to physician fee schedule • Insures focus on ICD-10 coding conventions to insure proper claims processing • Insures accurate application of the CCI Edits and Modifier 59 prior to claims processing • Monitors, analyzes and trends data for improvement in areas such as: treatment days, CPT utilizations, timed vs. procedural codes, application of modifiers, g-codes, etc. • Work with the Outpatient team on documentation and coding readiness for new clinics • Provides oversight of the Medicare appeals processes; facilitates the review and approval of documentation prior to submittal. • . Responds to, coordinates, educates and supports the fields on audits including: Medicare probes, Focused reviews, RAC’s, SMRC’s ZPIC’s, OIG audits, and others • Analyzes appeal trends and educates the field accordingly • Develops and/or refines systems and processes to insure standardization of practices and compliance with Medicare/third party rules and regulations • Insures the availability of an current policy/procedure manual that is comprehensive and reflective of established business practices • Provides comprehensive monthly reports for all levels of appeals • Performs audits remotely and in the field • Other duties as assigned by the Vice President of Rehab and Wellness Services • Provides supervision to Medical Record Reviewer Qualifications • Graduate of an accredited Bachelor, Masters, or Doctorate program of Physical, Occupational or Speech Therapy. • Must possess advanced experience in Rehabilitation: operations, reimbursement, and regulatory compliance. • Strong clinical and teaching skills are required. This person must be able to communicate professionally with various levels of personnel throughout the organization • This position is based at Five Stars' Corporate office in Newton, MA. License Certification Most hold a license as a Physical Therapist, Occupational Therapist or a Speech-Language Pathologist EEOC Five Star prohibits discrimination against any employee or applicant for employment with regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, marital status, genetic information, disability or veteran status. In addition to federal requirements, Five Star complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has communities and/or facilities. This policy applies to all terms and conditions of employment, including, but not limited to, recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.