CLINICAL REIMBURSEMENT COORDINATOR-RN- Per Diem

2 weeks ago

Pittsfield, United States INTEGRITUS HEALTHCARE MGT SERVICES, INC Full time
Job DescriptionJob Description

· Perform independent and/or suggested affiliate level, clinical and financial audits as warranted.

· Identify and assist with educational opportunities through audit, tracking, trending, and analyzing relevant patient data with supervisor guidance and support.

· Strategic planning as relates to ARDs to optimize appropriate revenue systems.

· Ensure IDT compliance with state/federal requirements and timeframes related to MDS, billing and care planning.

· Provide high level interpretation of revenue related data as requested.

· Identify revenue related risks associated with missing, irrelevant, erroneous clinical documentation. Assist with action plans related to such risk.

· Assist with orientation and education for CRCs and other IDT members as relates to MDS and/or reimbursement processes.

· Provide ongoing education and communication with IDT as relates to current state and federal regulation systems driven by the MDS.

· Review clinical charts to determine skilled need and assist with determining appropriate Length of Stay.

· Attest to completion of MDS at section Z. Sign MDS completion for any LPNs in the department.

· Develop and revise care plans as per facility protocol. Attend/Lead CP meetings per facility protocol.

· Conduct daily, weekly, monthly meetings related to Revenue. (Daily REV, Wkly MRA/CMI, Monthly Triple check)

· Ensure the timeliness of managed care updates.

· Assist with maintenance, risk and education related to 5 STAR Quality Measures/Value Based Purchasing, and Quality Reporting programs.

· Provide information as requested for Additional Documentation Request (ADR).

· Other related duties as assigned.

Qualifications:

· MA licensed nurse with 3+ years reimbursement or similar experience in the LTC industry.

· Computer literacy (Word, Excel, Power Point, Outlook).

· Experience with current EMR (NTT) software a plus.

· Evidence of effective written, verbal, and technological communication.

· Demonstrates excellent organization, communication, and presentation skills.

· Deadline driven, detail-oriented individual with strong analytical capabilities.

· Working knowledge of state and federal regulations governing the MDS and billing processes within a nursing facility. (CMI/PDPM/Managed care, QRP/VBP)

· Ability to communicate with and elicit support from other IDT members at the affiliate level.

· Ability to apply knowledge in state specific Medicaid and Medicare CMI/PDPM methodologies.

· Exhibits independent and self-directed work ethic.

· Must exhibit excellent interpersonal relations, time management, family and customer relations and job knowledge.

· Must be able to read, write, speak, and understand the English language.

Education

· Graduate of accredited RN Program required

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