Regional Clinical Reimbursement Specialist
Clinical Resources LLC - United States

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REGIONAL CLINICAL REIMBURSEMENT SPECIALIST OPPORTUNITY! We are currently Sourcing for a Clinical Reimbursement Specialist for a LTC company, open to candidates throughout MA. There is an immediate need for the right Health Care candidate who is in search of a competitive compensation plan. If you or someone that you know may be interested in this exciting health care opportunity please feel free to call Arlen Crawford at 1-888-800-3377 or email him at! Our client prides itself on their experienced and professional staff, and is committed to providing quality health care and service excellence, while treating their patients with the utmost dignity and respect. Come join a well respected team of health care professionals! REGIONAL CLINICAL REIMBURSEMENT SPECIALIST JOB DUTIES:
• Identifies, tracks and reports clinical reimbursement trends to necessary employees.
• Facilitates recruitment, orientation, evaluation and retention of staff.
• Conducts Medicare Validation Audits to assure accuracy of MDS coding and reimbursement.
• Maintains relationships with case managers from the contracted managed care organization.
• Conducts Managed Care Audits to assure compliance with the contract.
• Participates in and/or conducts clinical reimbursement related calls.
• Facilitates the interdisciplinary team development of action plan(s) to improve clinical reimbursement processes including: o Validating accuracy of MDS data o Reducing and eliminating MDS defaults o Ensuring proper Medicare certification/recertification procedures are in place o Monitoring Medicare length of stay o Ensuring accurate case mix indices are assigned to residents o Monitoring and enforcing corporate MDS submission guidelines o Educating regarding selection of appropriate assessment reference dates o Improving efficiency of interdisciplinary care planning process o Partnering with the therapy program o Evaluating and enhancing the restorative nursing program o Evaluating and improving the admission process o Partnering with Medicare Review to ensure that accurate ADR information is submitted to the fiscal intermediaries o Assisting in the Medicare appeal process o Reviewing Medicaid state audit results and implementing plans of corrections o Conducts RAI education and training as identified for CRC/CRS staff, interdisciplinary team members and other regional staff. o Conducts RUGs-based education and training as identified for CRC/CRS staff, interdisciplinary team members and other regional staff. REGIONAL DIRECTOR OF CLINICAL REIMBURSEMENT SPECIALIST BACKGROUND PROFILE:
• Registered Nurse (RN) Licensure required.
• One to three years of previous experience as an MDS Coordinator or MDS Consultant.
• MDS 3.0 required.
• Multi-facility management experience preferred.
• Strong understanding of PPS Medicare Reimbursement and Case Mix Reimbursement required.
• Strong organizational and project management skills.
• Ability to lead and direct projects and project teams. “We invite you to view this opportunity and many other exciting positions on our company website at: Click on this link and see “Career Opportunities" on the left side of the page!"