In today’s spotlight, we’re featuring a non-clinical PTA who works as a Clinical Review Specialist and Subject Matter Expert (SME).
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What is your full name and title at your current job?
Kelly Hettenbaugh, PTA, B.S., M.S.
Clinical Review Specialist, Subject Matter Expert, Alternate Solutions Health Network
Where are you located?
Fort Myers, FL
Where did you go to PTA school, and what year did you graduate?
PTA: Broward College located in Coconut Creek, FL (I attended at the SWFL Edison College campus satellite program). I graduated in 2014.
What did you do when you first finished school, and for how long?
I worked as a physical therapy tech at an outpatient clinic for six years prior to and during school, from 2008-2014.
I was then hired as a PTA after gaining licensure in 2014, and I continued working there until 2017. Medical & Sports Rehab in Naples, FL was composed of two small, privately owned outpatient clinics that provided PT/OT/LMT/Certified Hand Therapy services.
My patients ranged from a 5-year-old, high school and college athletes, post-op ortho rehab, to my oldest patient at 103-years-old for general conditioning. The owner, and supervising PT, was a follower of Dr. Janet Travell, and treated heavily with manual therapy and trigger point therapy.
As newer therapists were hired, I could see a transition to an emphasis on therapeutic exercises/activities in their treatment methods. I was happy to utilize both, and thankful for the wide range of training with treatment options.
What did you do after that, and for how long?
In 2017, I was starting to become more heavily involved in charity and young professional groups, as well as traveling more. These passions lead to a desire for a setting with more flexibility than the Monday-Friday 8am-5pm schedule.
I reached out to a former PT that had worked for the company, and then opened his own company. Unfortunately, due to restrictions with the nature of his business, they could not employ PTAs; however, he suggested looking into home health.
Fortunately, one of the clinical rotation assignments I had during school was a combined outpatient/home health company located within ALF/ILF buildings. It felt like a good combination to test my feet in home health, with the comfort of outpatient. This also allowed me to work longer days to get in higher visit counts early in the week, and more flexibility at the end of the week, or to leave early for meetings, if needed.
This setting was a variety of patient care, but heavily focused on functional mobility within the living facilities, fall prevention, safety education, and assistive device training. During this time, I also became one of the lead therapists in the building, and was asked to attend the weekly multidisciplinary meetings with facility staff, home health staff, and on-site medical staff, as a representative of our therapy team. I continued in this role until moving out of state in 2019.
Upon moving out of state, I stuck with the flexibility of home health, and joined INOVA Home Health, in Northern Virginia, outside of Washington, D.C.
What did you enjoy about your early roles? What didn’t you enjoy?
I greatly enjoyed the interaction with patients and their families. As any healthcare professional, I loved helping patients return to their desired abilities, goals, and functional levels. In the outpatient clinic, I loved my coworkers, who had become a second family in those 8.5 years!
What I didn’t enjoy was the response from the few patients when they didn’t improve in the way they wanted (time, level, etc.). I had some patients who had very poor attitudes, or family members who couldn’t understand why the patient wasn’t improving. It became very frustrating, discouraging, and defeating at times.
At what point did you realize you wanted to do something non-clinical with your background, and why?
I have always wanted to be involved in administration, getting to know every aspect of the business side of the therapy field. I believe this stemmed from my mother’s career. She was a RN who became the director of multiple care units in a hospital in New York, and then Florida.
While I knew it was a large undertaking, I felt it would be a role that I would succeed in. I knew having the clinical background would aid in making this happen. However, I did not take in to account the burnout that I, and so many others, would start to experience.
I was giving my heart, soul, physical, and mental energy to every patient encounter—and it was wearing on me.
What are you doing these days?
I work as a Clinical Review Specialist for Alternative Solutions Health Network (ASHN).
INOVA Home Health is overseen by an umbrella company called Alternate Solutions Health Network, which supports multiple home health companies located in OH, VA, WV, MI, and FL. ASHN handles all business aspects, including scheduling, human resources, training, billing, etc.
While attending a therapy team training meeting, an ASHN corporate employee briefly mentioned they were working to create a role to include a team of therapists to their Clinical Review Specialists team (which was RNs and LPNs filling the role at the time).
The Clinical Review Specialist is responsible for reviewing charts and orders entered by field staff for compliance, unintentional errors, and following plans of care. The Clinical Review Specialist is also a second set of eyes for quality assurance.
My specific role is to review therapy orders and calendars entered by the field staff for compliance. Additionally, if additional visits are requested after the initial plan of care, we review for medical necessity as outlined within the Medicare guidelines.
Our goal within the company is to avoid denial of payment, as well as unjustified care. I currently work four 10-hour days, and alternating weekends.
Nice! How did you land the Clinical Review Specialist role?
When I heard about this role, I approached the aforementioned employee to ask him for more information. I knew this would be a great opportunity to learn more about the processes implemented in the internal aspects of patient care. Upon interview, an extensive six-week training (virtual due to COVID shutdowns), myself along with two COTAs became the first ever therapy professionals to join the CRS team!
Are you still treating patients, or are you solely non-clinical?
I am currently solely non-clinical, and remote.
How long have you been in your current role?
I have been in this role for just over one year!
Did you do anything special to your resume and cover letter to land the job?
I did. Under my previous experience, I highlighted relevant roles and tasks that I completed while in those positions.
There are so many skills that we have as therapists outside of just treating! Communication, organization, attention to detail, and time management are all necessary to treating, as well as non-clinical roles.
It all boils down to thinking outside of the box! We are trained on resume building to highlight our clinical skills, but for non-clinical roles, it’s necessary to point out the other attributes!
What was the interview like for the role?
The corporate office is located in Dayton, OH, and I was living in VA. I interviewed in my car, via the Zoom app on my phone. They were very understanding that I was still working in the field, and treating patients.
I met with two of the managers of the Clinical Review Specialist department. During the interview, I asked them to tell me more about the newly created role. I was sure to mention the skills and attributes that my clinical experience taught me, that would carry over to the role.
They also mentioned that they hire a lot based on personality, they don’t question clinical skills, and they can train on the processes. Someone from HR emailed me preparation information, as they use behavioral interview questions as well.
Did you get any special certifications or training along the way to help you get into your current role?
Initially, I was to fly to Ohio for training, one week at a time and home on the weekends, however due to COVID, I was trained remotely, via Zoom. It was a very long, extensive six-week training on many processes within the workflow.
Because ASHN oversees and reviews orders in five states, I had to become licensed as a PTA in all five states. Luckily, I already had FL and VA from clinical care, I then obtained OH, MI, and WV. They reimbursed me for all costs, and I was able to leave for testing or fingerprinting during my work time.
Each state has varying requirements for jurisprudence exams, sending test scores, sending other state license verification, etc. I was able to help them develop a work tool for future PTAs coming in to the role, as a guideline for obtaining licensure in the other states.
How have people reacted to you leaving patient care?
I think there was a lot of surprise from former coworkers that I was leaving patient care. My patients always went out of their way to tell management, or supervising PTs how pleased they were with me. My patients expressed sorrow that I was leaving the field, and they would no longer be seeing me.
It was a difficult decision to make. However, I then think back to how burned out I was feeling, and know that I made the best decision for me.
What’s a typical day or week in the life like for you?
Working four ten-hour shifts, I am logged on my computer at 7 am to review emails and requests to process orders that may have a visit plotted for the same day.
Workflow consists of reviewing orders for compliance and medical necessity. While click reports are run, our productivity also includes clearing any workflow that has arrived prior to 4:45pm.
We work at our own pace, and offer to help in other areas if caught up with our own work. Some staff works Monday-Friday 8am-5pm, so from 5pm-6pm we help clear workflow and tasks that may be left over, until I log off at 6pm.
What are some of the challenges of your role? What are the rewards?
When reviewing orders to extend therapy, we review documentation to indicate medical necessity to continue. If the documentation isn’t there, CMS can deny the entire episode of care. As we are reviewing, we reach out to the clinicians to advise that the maximum number of visits requested cannot be approved. Often times the clinicians get upset with this decision and can have some very negative responses. Trying to communicate that we are questioning their documentation, and not their clinical judgement can take a tough coat to not take it personal when they respond.
How do you think working as a PTA prepared you for this role? Which skills transferred?
There are so many of our skills that carry in to this role! Time management, stress management, communication, liaising, prioritization, independence and self-actualization!
Roughly speaking, how are the hours and pay compared to patient care?
I did take a pay cut from my clinical role. I was seeing 30 patients per week, however with drive time, and scheduling, I was working over 40 hours. Now, I am working 40 hours, with no travel time, and no after work responsibilities once I log off.
With the pay cut, but increased paid hours, it did not come out financially even, but it did cut my stress level down dramatically, and increase my quality of life. I am paid roughly what I started at as a new grad.
What type of person do you think would do well in your role?
Someone in this role must be self-driven with good time-management skills, as nobody is there watching your every move or micro-managing.
However, if you fail an audit on productivity, you must return to the nearest office for 6 months, before you are eligible to work remotely again. Additionally, you must be extremely detail-oriented when reviewing the orders and charts.
Do you work remotely or on-site?
Does your organization hire PT, OT, or SLP professionals into non-clinical roles?
Currently, the Clinical Review Specialist role is filled with PTAs and COTAs. As the program was initiated, current PTs from the field were working partially in the field, and a few hours from the office doing the reviews.
The goal is to transition to the PTAs and COTAs filling the role, and the PTs returning to field work.
Did you read any books, take any courses, or do anything special overall to get you where you are today?
Not really… unless textbooks in school count?!
Check out these MedBridge courses on billing and documentation! They can help you earn CEUs while you figure out whether this career path is right for you!
- Documentation for Evaluations and Re-Evaluations
- Documentation: Everything After the Evaluation Through the Discharge
- CPT Codes Most Commonly Used by SLPs
- CPT Codes Most Commonly Used by PTs and OTs
- NCII Edits and Billing for SLP Services
- NCII Edits and Billing for PT & OT Services
What is a typical career path for someone in your role?
That is currently to be determined, since this is a newly created role. The opportunity for growth is still developing.
There is a therapy manager, along with 4 other Clinical Review Managers. Above there, there is an extensive executive team within the company with many roles regarding quality assurance, performance improvement, and joint venture growth.
What is next for you? What do you want to do with your career long-term?
“Having recently graduated (May 2020) from Saint Francis University, with my Masters in Health Science with a Leadership track, I would like to go in to management and administration eventually.
This role is allowing me to learn the internal aspects of the field, which I was not able to experience during my clinical roles.
What would you recommend to someone who is considering going into a role like yours? Do you have any special words of wisdom for the readers?
Keep looking! The roles are out there, and I believe there is going to be a transition to using therapists in non-clinical roles due to our knowledge and experiences.
There is proof that having a clinical therapy background improves the level of review and interpretation of the documentation.
If you could give yourself one piece of career advice you wish you had during PTA school, what would it be?
Never stop learning! Continue to ask questions, get involved as much as possible, and learn everything that you can from everyone that you encounter!
The road won’t be easy, and you will likely not take the exact path you expected, but the knowledge you gain will be worth it. Also, you are never stuck in any position; there are a million options out there.
Do you have any special advice for others who want to follow in your footsteps?
Believe in your abilities. We have a lot to offer outside of our clinical roles. It is great to have that clinical background, but it can be applied to so many other areas. Keep looking until you find the best role for you, and then continue to go for it.