Clinical Reimbursement Manager

6 hours ago


Wallingford, Connecticut, United States Masonicare Corp Full time
Job Summary

Masonicare Health Center seeks a highly skilled Clinical Reimbursement Manager to oversee the facility's reimbursement processes and ensure accurate and timely payment from payor sources.

Key Responsibilities
  1. Coordinate and manage the Resident Assessment Instrument (RAI) process to capture accurate resident-related data and maximize reimbursement potential.
  2. Ensure accurate documentation of all services to facilitate reimbursement from payor sources.
  3. Conduct performance reviews and staff evaluations, as well as participate in the hiring process.
  4. Develop and implement standards of performance, evaluate staff performance, and make recommendations for staff development.
  5. Review facility quality indicators and identify areas for improvement.
  6. Communicate with patients, families, and interdisciplinary care teams regarding Medicare benefits and skilled needs.
  7. Organize and participate in daily Medicare meetings, utilization review, and monthly end-of-close meetings.
  8. Assist with Medicare denial claims and reviews as needed.
  9. Stay up-to-date with changes in Medicare, Medicaid, and managed care regulations, as well as MDS/RAI processes.
  10. Continuously evaluate and improve job area processes to meet changing market, federal, and state mandates.
Requirements

Requires a Registered Nurse with a current Connecticut State license and a BSN or MSN graduate degree from an accredited school of nursing.

Experience: Requires at least 3-5 years experience in geriatric nursing; at least two (2) years experience with federal Medicare/Medicaid and Managed Care reimbursement systems, with a thorough working knowledge of the MDS and RAI process; requires a working knowledge of OBRA regulations as they relate to Skilled Nursing facilities; requires strong working knowledge of statistics, data collection, analysis, and presentation.

Certificates, Licenses, Registrations: Current Connecticut State RN licensure required.



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