Clinical Reimbursement Specialist RN
5 days ago
Clinical Reimbursement Specialist RN
StoneGate Senior Living
Dallas/Fort Worth, TX
StoneGate Senior Living in Dallas/Fort Worth, TX is hiring a Clinical Reimbursement Specialist, RN. StoneGate Senior Living provides support services to over 30 state-of-the-art senior care communities located in the DFW area.
StoneGate’s Clinical Reimbursement department has an excellent opportunity for an experienced Clinical Reimbursement Specialist, RN.
The Clinical Reimbursement Specialist RN will act as a primary resource person for the facility management staff. Coordinating internal Skilled Nursing Facility operations to assure compliance with CMS Medicare guidelines, Managed Care case management policy and procedures, and Medicaid reimbursement criteria to improve quality census mix. This position also requires the expertise to educate all facility staff on Medicaid and to perform appropriate audits to ensure compliance with government and state rules and regulations.
We offer competitive compensation, health, dental, and vision insurance, company paid life insurance, holiday pay, paid time off, employee appreciation events and much more.
At StoneGate Senior Living in Dallas/Fort Worth, TX, you will be a part of a well-respected facility that is making an impact in the lives of our residents, our team, and the community in which we serve. We look forward to you joining our team
KEY RESPONSIBILITIES
- Routinely visits assigned facilities to review, monitor and/or audit the provision of Medicare services provided within the facility.
- Provides the dissemination, interpretation, understanding and application of changes in Medicare, Medicaid and Managed Care Program, Medicaid Tiles in conjunction with other corporate personnel. Provide education to all appropriate personnel, presenting both in the field and through telephone contact.
- Provides consistent consultation utilizing clinical judgment and the nursing process to develop the Medicare and Medicaid programs. Together with the facility Medicare team and other corporate personnel, ensures that all Medicare eligible and Medicaid Tile residents receive the maximum coverage allowable, and that the facility team makes appropriate informed coverage decisions.
- Acts as a resource in identifying Medicare entitlement and eligibility for prospective Medicare residents, resulting in appropriate program utilization.
- Coordinates all facility activities in regard to the appraisal of facility’s Medicare, Medicaid, Managed Care program and problems, as well as actions, which need to be taken with respect to suggested changes. This is to encompass both verbal communication as well as copies of written recommendations.
- Through telephone, fax, and on-site review of care plan documentation, ensures patient care issues are addressed, follow Medicare coverage criteria, meet the resident’s medical needs, promote recovery and ensure medical safety.
- Assists facilities in meeting the technical requirements to promote a quality Medicare program by reviewing and making recommendations as to the timeliness, completion and issuance of appropriate denial letters, certifications, and re-certifications.
- Through management reports monitor facilities for completion of timely MDS’s data entries and communicate with corporate and facilities the issues and trends that are beneficial for success.
- Complete appropriate areas of the Mock Survey.
- Teach effective Significant Change management to improve reimbursement and QI management.
- Monitor effectiveness of daily, weekly Medicare A meetings and Care Plans.
- Teach and train the Resident Assessment Information Process.
- Assists in the hiring and mentoring the MDS Coordinator in facilities.
- Trains/assists facilities with computer applications.
Qualifications:
- Current valid RN license in the state of Texas.
- Thorough knowledge of application of state/federal regulations and standards of care.
- Minimum of three years’ experience in long-term care, preferably as a Director of Nursing with Medicare/Medicaid/MDS background.
- Management/Supervisory experience required.
- Strong interpersonal skills and communication skills.
- Written and Verbal skills required.
- Travel is required, must have reliable transportation.
- Must be flexible and able to set priorities with minimal supervision.
Job Requirements
- Must be a licensed RN in good standing in the State of Texas
- Must have excellent interpersonal and telephone skills and the ability to relate professionally and positively to referral sources, physicians, patients, patient families, and other team members and consultants at all levels.
- Must be detailed oriented and possess the ability to multitask.
- Prior Case Management experience is required
- Proficient computer skills
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