Clinical Reimbursement Specialist/Regional Mds Nurse

Position Summary

The Clinical Reimbursement Specialist ensures correct monetary reimbursement for any services offered to patients and residents covered by insurance programs by reviewing patient records and clinical care programs. in accordance with all applicable laws, regulations, and Life Care standards.

Please note: This is not a remote position and does require travel to the facilities!

• Opportunities to develop and implement systems to enhance the MDS experience at the facility, regional and divisional level
• Active participant with regional team in the development of clinical systems that ultimately impact reimbursement
• Coordination of remote and float MDS-Cs schedules to ensure Skilled Nursing Facility coverage and support
• Flexibility and autonomy in providing oversight to Skilled Nursing Facility MDS-Cs
• Supports the MDS functions of multiple Skilled Nursing Facilities in Western WA and Oregon, from Skagit Valley, WA to Eugene, OR

Education, Experience, and Licensure Requirements * Registered nurse with an active state license and MDS and RAI experience

Specific Job Requirements

• Train and inspire facility level and remote pool of MDS-C
• Must be knowledgeable of practices and procedures as well as the laws, regulations, and guidelines governing functions in the post acute care facility
• Maintains professional working relationships with all associates, vendors, etc.
• Prepare and provide Clinical Reimbursement Quality analysis
• Displays integrity and professionalism by adhering to Life Care’s Code of Conduct and completes mandatory Code of Conduct and other appropriate compliance training
• Must have the ability to implement and interpret the programs, goals, objectives, policies, and procedures of the department
• Identify coding opportunities to maximize Case Mix Index (CMI) and PDPM reimbursement
• Maintains confidentiality of all proprietary and/or confidential information
• Must understand and follow company policies including harassment and compliance procedures
• Must possess the ability to make independent decisions when circumstances warrant such action
• Coordinate with Divisional Director of Clinical Services to ensure resident care planning needs are met
• Coordinating with facility to ensure ARDs capture services for maximal reimbursement
• Must perform proficiently in all competency areas including but not limited to: patient rights, and safety and sanitation

Essential Functions * Must exhibit excellent customer service and a positive attitude towards patients

• Must be able to concentrate and use reasoning skills and good judgment
• Must be able to read, write, speak, and understand the English languageAn Equal Opportunity Employer
• Must be able to sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours
• Must demonstrate dependable, regular attendance
• Must be able to assist in the evacuation of patients
• Must be able to communicate and function productively on an interdisciplinary team

Job Type: Full-time

Pay: $115,000.00 - $120,000.00 per year

Benefits:

• Dental insurance
• Employee assistance program
• Flexible schedule
• 401(k)
• Life insurance
• Vision insurance
• Disability insurance
• Health insurance
• Paid time off

Medical specialties:

• Geriatrics

Schedule:

• Day shift

Education:

• Associate (Preferred)

License/Certification:

• RN (Required)

Work Location: Multiple Locations