Reimbursement Specialist - Healthcare jobs in Saint Petersburg, FL

A privately owned company that owns skilled nursing facilities in multiple states is looking for a strong Regional Director of MDS/ Reimbursement to oversee their facilities.

Responsibilities:

• Promote the capturing of appropriate clinical reimbursement for services provided while ensuring the highest level of revenue integrity

• Trending, tracking, auditing, and analyzing data for reimbursement and support of the coding of the MDS

• Review of current reporting systems to audit facility MDSs and determine modifications needed as appropriate, as well as providing education to the facility on the reasons for the necessary modification

• Training and education of the facility team as it relates to current state and federal regulations for reimbursement and payment models for both PDPM and state specific Medicaid models and CMI

• Maintain compliance with state-specific regulations regarding the RAI process

• Be knowledgeable of regulations, practice standards, and procedures, as well as laws, regulations, and guidelines pertaining to the RAI process and payment methodologies for all payers, including, but not limited to CMS and PDPM

• Conduct regular facility visits to support the teams in each facility while providing a visit report to the regional team and the Corporate Director of Clinical Reimbursement

• Complete monthly reporting of MDS concerns, staffing issues, average CMI for PDPM and Medicaid, at a minimum, by facility

• Ongoing communication and collaboration with the regional and corporate teams

• Work effectively with individuals at all levels including the facility staff, regional and corporate team members as well as vendor partners

• Plan, organize, prioritize, work independently and meet deadlines

• Foster effective working relationships and build a culture with a team mentality

Qualifications:

• Must have a current RN license

• Must have long term care experience

• Must have experience as a Regional Director of Reimbursement

• Must know MDS 3.0