Reimbursement Specialist

Responsibilities: Responsible for the oversight, planning, and support of the Minimum Data Set (MDS) program. This position supports facility employees in all aspects of RAI Systems and Reimbursement.

Qualifications:

• RN/LVN license in good standing with the State of Texas.
• Three years of MDS completion in LTC.
• Managed Care experience preferred, but not required.
• Excellent written and verbal communication skills.
• Good attention to detail with the capability of maintaining confidentiality.

Essential Functions:

• Supports the development and compliance of RAI systems through the use of various supporting technological applications to ensure an appropriate level of resident care and timely reimbursement of the care provided.
• Responsible for the compliance, leadership, growth and profitability of assigned programs within the region.
• Uses standardized reports that include analysis and opportunity for discussion, strategizing, planning, implementation, monitoring and action planning.
• Develops and implements training strategies with the Interdisciplinary Field Support for all payer types including PPS, Managed Care and State Medicaid Case Mix Reimbursement.
• Monitors and promotes RAI processes and tools to assure delivery of quality of care to residents.
• Participates in CMS and State initiatives as related to nursing facility assessment and reimbursement systems.
• Provides support to facility teams for clinical reimbursement strategies, systems implementation, training and team development.
• Monitors and supports all operational, administrative, clinical and fiscal activities of assigned programs and services to insure quality and consistency with company standards. This includes education and training of all region and facility team members.
• Directly responsible for ensuring that the quality and appropriateness of patient care meets or exceeds company and industry standards and ensures that all services are in compliance with state and federal legal, regulatory, accreditation and reimbursement guidelines.
• Assists with the development of corrective actions, best practices and/or education to appropriate employees.
• Conducts facility visits as needed to identify strengths and opportunities.
• Provides information to identify trends, variances, practice patterns and opportunities for improvement as part of the Regional QAPI process to promote positive outcomes.
• Provides orientation/training and retains a sufficient number of qualified staff to carry out the responsibilities of the MDS function.
• Assists facilities with OIG reviews and regulatory surveys as needed.
• Completes required forms and documents win accordance with company policy and state and/or federal regulations.
• Performs other duties as assigned.
• Frequent travel throughout Texas.

AA/EEO/M/F/D/V