Reimbursement Specialist - Healthcare determines the extent to which patients' insurance covers their treatments. Reviews appropriateness of CPT-4/ICD-10 coding and determines if care provided corresponds to the charges submitted. Being a Reimbursement Specialist - Healthcare ensures compliance with Federal and State regulations and company policies that govern Medicare and state payment systems. May assist in identifying fraudulent non-plan billing practices and assists the legal department with litigation preparation. Additionally, Reimbursement Specialist - Healthcare may require a bachelor's degree. Typically reports to a supervisor or manager. Typically requires Certified Professional Coder (CPC) from AAPC or AHIMA. The Reimbursement Specialist - Healthcare gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Reimbursement Specialist - Healthcare typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS division as a Clinical Reimbursement Specialist. A minumum of a Bachelor's degree in nursing or therapy is required.
The Clinical Reimbursement Specialist (CRS) is responsible for project work for clients such as, RAI assessments, Care Plan development, education and training to the MDS Coordinators in the facilities on the Resident Assessment Instrument (RAI) process in accordance with the laws, regulations, and company standards. The CRS also reviews reimbursement systems for PDPM and Case Mix reimbursement to ensure appropriate reimbursement and assists contracts with interim long term and short team coordination and completion.
What do we offer you?
Key Rehab is an equal opportunity employer/service provider.