ADVANCED PRACTICE PROVIDER - BEHAVIORAL HEALTH - CARE COORDINATION

Care Coordination and Disposition

• Collaborates closely with Behavioral Health Case Management, Acute Case Management, and community behavioral health providers.
• Supports timely determination of the most appropriate level of behavioral health care.
• Facilitates transitions to inpatient psychiatric treatment, outpatient behavioral health services, crisis programs, substance use treatment, primary care, and community resources.
• Identifies and addresses barriers contributing to prolonged Emergency Department or hospital length of stay.
• Communicates behavioral health recommendations clearly to patients, families, and the healthcare team.

Billing, Coding, and Revenue Cycle Responsibilities

• Provides billable behavioral health evaluation, consultation, and treatment services in the Emergency Department and acute care inpatient setting in accordance with applicable federal and state regulations, payer requirements, and organizational policies.
• Completes documentation necessary to support accurate and timely professional billing for services provided.
• Selects and/or supports assignment of the appropriate level of service and applicable CPT/HCPCS codes consistent with organizational coding and compliance requirements.
• Ensures documentation supports medical necessity, complexity of care, diagnoses, services rendered, and level of service billed.
• Completes and closes encounters within established organizational timeframes to support timely charge capture and claims submission.
• Collaborates with Coding, Revenue Cycle, Compliance, and Finance to address documentation or billing opportunities and ensure appropriate reimbursement.
• Maintains required credentialing, enrollment, and payer participation necessary to bill independently or under the appropriate organizational billing structure.
• Participates in education and audits related to documentation, coding, billing compliance, and revenue optimization.
• Monitors individual productivity and professional revenue performance as established by the organization.
• Supports appropriate capture of professional revenue associated with behavioral health consultations, psychiatric evaluations, medication management, and follow-up services provided in Emergency Services and acute care.

Collaboration and Communication

• Maintains effective collaborative relationships with Emergency Services, Hospital Medicine, Psychiatry, Nursing, Case Management, Security, and other clinical departments.
• Communicates significant changes in patient condition and safety concerns promptly.
• Participates in behavioral health interdisciplinary rounds, complex case reviews, or throughput discussions as appropriate.
• Serves as a behavioral health clinical resource to acute care staff.

Documentation

• Completes timely, accurate, and comprehensive documentation in the electronic medical record.
• Documents psychiatric assessment, diagnosis, risk assessment, treatment recommendations, medication management, disposition recommendations, and follow-up plan.
• Completes documentation consistent with regulatory, accreditation, billing, and organizational requirements.

Quality and Performance Improvement

• Participates in quality improvement initiatives related to behavioral health care in the acute care setting.
• Supports efforts to improve behavioral health patient safety, Emergency Department throughput, appropriate utilization, and transitions of care.
• Participates in review of behavioral health length of stay, ED boarding, readmissions, repeat ED utilization, safety events, and other identified performance measures.
• Identifies opportunities to improve behavioral health workflows and interdisciplinary care processes.

Competencies Skills

• Timeliness of behavioral health consultation and psychiatric evaluation.
• Behavioral health ED length of stay and reduction in avoidable ED boarding.
• Timely reassessment of behavioral health patients awaiting disposition.
• Appropriate disposition and level-of-care determination.
• Psychiatric consultation response time for hospitalized patients.
• Behavioral health 7- and 30-day ED revisits/readmissions.
• Professional charges generated and successfully captured.
• Percentage of eligible encounters billed and timeliness of encounter closure/charge submission.
• Documentation and coding accuracy and documentation-related denial performance.
• Work RVUs and/or other organizational productivity measures, when applicable.
• Professional revenue compared with established budget and productivity expectations.

Requirements

Experience

• Two or more years of psychiatric/behavioral health advanced practice experience.
• Experience in an Emergency Department, acute care hospital, psychiatric consultation-liaison service, inpatient psychiatric setting, or behavioral health crisis program.
• Experience evaluating patients with complex psychiatric, medical, substance use, and psychosocial conditions.

Credentials

Education

• Master's or Doctoral degree in Nursing from an accredited Nurse Practitioner program.
• Graduate preparation appropriate for psychiatric/behavioral health advanced practice.
• Current Advanced Practice Registered Nurse licensure in the state of practice.
• Current national board certification as a Psychiatric-Mental Health Nurse Practitioner (PMHNP-BC), where required by scope of responsibilities.
• Prescriptive authority consistent with state law and organizational credentialing requirements.
• DEA registration if required for assigned responsibilities.
• Current BLS certification and required crisis intervention/de-escalation training.