Clinical Reimb Spec
Arbors At Gallipolis - Gallipolis, OH

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Seeking qualified Registered Nurses ( RN) or Licensed Practical Nurses ( LPN) to provide dedicated, compassionate service to the residents in our skilled nursing care / rehabilitation center in the role of Clinical Reimbursement Specialist ( MDS Nurse).


· Under the direction of the Clinical Reimbursement Coordinator ( CRC, MDS RN) responsible for the coordination of the Resident Assessment Instrument ( RAI) process to ensure accurate and timely completion of resident assessments in accordance with Medicare, Medicaid, OBRA and other payor program requirements.

· Ensures assessments accurately reflect the physical, mental and psychosocial status of each resident; ensures accuracy of RAI to reflect optimal reimbursement for services provided; ensures appropriate documentation to report and support services provided and assessment accuracy.

· Communicates effectively with other members of the interdisciplinary team.

· Follows all Extendicare policies and procedures.

Essential Functions

A: RAI Process

· Works in collaboration with the Facility Rehab Coordinator to ensure the most appropriate assessment reference date ( ARD) is utilized for Medicare Assessments through the use of the PPS Pathway.

· Initiates, directs and maintains the Medicare PPS/OBRA Assessment schedules to ensure timely completion of all assessments.

· Collaborates with the interdisciplinary team to set appropriate ARD for all assessments.

· Ensures all new admissions have an MDS completed

· Ensures each quarterly MDS is accurate, complete and timely.

· Ensures each annual assessment is accurate, complete and timely.

· Collaborates with interdisciplinary team to identify significant change in status and implementation of Significant Change in Status MDS.

· Initiates and completes Discharge and Re-entry tracking forms accurately and timely.

· Performs Modifications/In-activations of assessment in accordance with the CMS Correction Policy.

· Verifies timely transmission of MDS Assessments, including tracking forms, to the State in accordance with EHSI standards.

· Maintains a current knowledge base regarding State and Federal Regulations, PPS and the RAI Process.

B: Case Management

· Reviews medical records, care plans, charting to ensure documentation supports care provided and reimbursement level.

· Participates in Quad check prior to release of claims.

· Reviews State MDS validation reports to identify issues and/or processes to ensure accuracy of submitted MDS’s.

· Complies with laws and regulations applicable to position and acts in accordance with Extendicare’s Corporate Compliance Program.


· Possesses a current license to practice in the State as an RN or LPN

· Working knowledge of the MDS and RAI process

· Strong interest in Medicare, Medicaid, and other payor reimbursement systems

· Able to relate positively, effectively, and appropriately with residents/patients, families, community members, volunteers and other facility staff.

· Able to read, write, speak and understand English.

· Ability to apply basic mathematical skills

· Basic computer skill.

· Strong written and verbal communication skills

We strive to provide our employees with the tools necessary for development and success.

Extendicare, helping people live better!


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