Clinical Reimbursement Specialist/Multi Facility

4 weeks ago

Everett, Washington, United States Sodus Rehab & Nursing Center Full time
Job Summary

We are seeking an experienced Clinical Reimbursement Specialist to support our MDS/MMQ teams in Massachusetts. The Clinical Reimbursement Specialist will work under the direction of the Corporate Director of Clinical Operations- MA division.

Key Responsibilities
  • Provides consultation, training, and support concerning the MA Medicaid, Medicare, Managed Care, and state case mix payment system for the assigned area.
  • Analyzes systems and processes to determine that federal and state regulations as well as company policies and procedures are followed.
  • Responsible for overseeing and completing MA MMQs in MA Facilities, PDPM and MDS OBRA completion as needed, responsible for compliance and reimbursement maximization.
  • Studies, analyzes, and reports period-over-period information and systems in order to identify trends and deviations from results in Medicare and takes appropriate actions.
  • Works in conjunction with teams to resolve issues affecting deviations from expected results. Recommends changes and performs follow-up to ensure that those recommendations are effectively implemented and monitored for appropriateness.
Requirements
  • Licensed as a Registered Nurse in the State of Massachusetts
  • Three to Five years of clinical experience in a long-term care setting, which includes supervisory, administrative, or consultative capacities.
  • Current knowledge of computer technology and systems.
  • Ability to work independently with minimal supervision and guidance.
  • Extensive knowledge/experience in MMQ, MDS, and back-up documentation required and extensive knowledge of state grouper and calculator field relative to MDS and MA Medicaid payment methodology.
  • Extensive knowledge of Medicare reimbursement, compliance, and eligibility.
What We Offer
  • Competitive compensation and benefit plans including: Competitive Pay, Medical, Dental, Vision Insurance, Generous PTO, Life and Disability insurance, 401k, Great Benefits Package, Fun, Family-Like Team, and Atmosphere.

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