Clinical Reimbursement Specialist

4 weeks ago


Livingston, California, United States CareOne Full time

pstrongClinicalReimbursementCoordinatorJobSummary/strong/ppTheClinicalReimbursementCoordinatorisakeymemberoftheCareOneteam,responsibleforensuringtheimplementationofcompanypoliciesandproceduresrelatedtoMedicareandManagedCarereimbursement.ThisrolerequiresastrongunderstandingoftheMDSprocessandtheabilitytointegrateinformationfromvariousdisciplinestomaintainaccuracyandcompliance./ppstrongKeyResponsibilities:/strong/pulliMaintainaprofessionalstandardofbehaviorwheninteractingwithstaff,residents,familymembers,orvisitors/liliFollowandupholdthecompanyCodeofConduct/liliFacilitateDailyPPSandWeeklyMedicaremeetings/liliKnowledgeofandcompliancewithHIPAAguidelines/liliKnowledgeofandabilitytodownloadreportsfromPointRight/liliKnowledgeofandabilitytodownloadstateandfederalreportsfromtheInternet/liliParticipateinMonthlyBillingReconciliationmeetings/liliCompleteMDS'sperscheduleasrequiredforMedicare,ManagedCare,andOBRAschedules/liliInitiate/UpdateCareplansasrequired/liliEnsurecompliancewithState,Federal,andPointRighttransmissionsandmakemodificationsasneeded/liliFacilitateandcoordinatewithotherdisciplinestomaintaincareplandevelopmentandongoingupdatesperMDSschedule/liliProvideupdatesasrequiredperManagedCarecontractguidelines/liliCommunicatepromptlywithfacilityteam/regionalconsultantanyissuesorconcerns/liliCompletionandissuanceofdenialletters,coordinationofMedicarecertificationcompletion,reviewofskillednursingdocumentation(includingCNAdocumentation)tosupportskilledneeds/liliServeasthecenterresourceforMDS/PPS;andstateMedicaidreimbursement/liliManageMedicareappealsprocess,andparticipateinAdministrativeLawJudgehearingsasneeded/liliImplementandparticipateinthecompanyprocessesdevelopedtoappropriatelymaximizereimbursement/li/ulpstrongRequirements:/strong/pulliGraduateofanapprovedRNprogram/liliCurrentRNlicenseinthestateandcredentialsasrequired/liliPriorexperienceinMedicarereimbursementand/orMDSexperiencepreferred/liliKnowledgeofManagedCarereimbursementsystems/liliWordprocessingandcomputerskills/liliExcellentoralandwrittencommunicationskills/liliExcellentabilitytomaintainaneffective,friendlyworkingrelationshipwithothers/liliBasicmathematicability;abilitytousecalculator/liliKnowledgeofqualityimprovementprocess,howitaffectsthe5Starreport,andabilitytoidentifyissuesortrendsandimplementcorrectiveactionplansasneeded/liliKnowledgeofthe5Starreport/liliExcellentattentiontodetail;wellorganized/liliAbilitytoprovideone-on-oneorsmallgroupeducationrelatedtoidentifiedareasofneed/li/ulpstrongAboutCareOne:/strong/ppCareOneisaleadingproviderofhealthcareservices,dedicatedtomaximizingpatientoutcomes.Wetreatresidents,theirfamilies,andeachotherwithrespect,dignity,andcompassion.Throughacollaborativeandconsultativeapproach,westrivetoprovideaframeworkofstrengthandstabilityforourcentersandcommunities./ppWeworktomaintainthehigheststandardsofcareandserviceforresidents,families,andourvaluedemployees.Weareproudtoofferacompetitivesalary,comprehensivehealthcarebenefits,401kretirementplan,paidtimeoff,opportunitiestoadvanceandgrowyourcareer,andmore./p



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