Regional Clinical Reimbursement Specialist/MDS

The Regional Clinical Reimbursement Specialist/MDS will provide guidance and oversight to assessment coordinators related to the MDS and subsequent reimbursement processes for accuracy in assessment completion and maximization of reimbursement. The Regional Clinical Reimbursement Specialist/MDS Coordinator ensures RAI guidelines are followed in the assigned region with a focus on resident care and maximizing financial reimbursement through the MDS process.

JOB DUTIES:

• Review of MDS assessments on a minimum of a daily/weekly/monthly/quarterly basis including; quarterlies, annuals, IPAS, significant changes and admission assessments to ensure scheduling and completion are in compliance with the RAI process and any related state and/or federal regulations to include CAA’s and the care planning process.

• Quarterly review of admissions/discharges to ensure discharge and/or re-entry assessments are present and dated appropriately.

• Review of Medicare PPS assessments on a minimum of a quarterly basis including dually coded full assessments to ensure accurate coding on all sections of the MDS with supportive documentation present to maximize financial reimbursement.

• Review of Medicare assessment scheduling on a monthly basis including unscheduled OMRA assessments

• Monthly review of skilled certifications/re-certifications to ensure appropriate documentation is present and signed by licensed professional in accordance with federal and/or state regulations.

• Monthly review of each facility RUG report to review distribution and monitor for any trends including fluctuations in ADL scoring or associated end split.

KNOWLEDGE:

• Knowledge and understanding of regulatory processes (Federal, and/or State Regulations)
• Knowledge of the RAI Regulations
• Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.

ABILITIES:

• Ability to work in a “Matrix” management environment
• The ability to listen to and understand information and ideas presented through spoken words and sentences.
• Ability to relate positively, effectively, and appropriately with residents, families, community members, volunteers, and other facility staff. Possess special interest in working with long-term care residents and the elderly.

CERTIFICATES, LICENSES, REGISTRATIONS

• Licensed RN

Job Type: Full-time

Benefits:

• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Travel reimbursement
• Vision insurance

Medical Specialty:

• Geriatrics

Physical Setting:

• Long term care

Schedule:

• Monday to Friday

Work Location: Multiple Locations