Clinical Reimbursement Specialist

1 week ago

Franklin Park, United States MDS Solutions Full time
Overview

MDS Solutions, a leading provider of healthcare solutions, is seeking a highly skilled Clinical Reimbursement Specialist to join our team. As a Clinical Reimbursement Specialist, you will play a critical role in ensuring our clients receive accurate and timely reimbursement for their services.

Responsibilities
  • Provide expert guidance to healthcare agencies and facilities on reimbursement optimization and compliance with federal and state regulations.
  • Assist clients with assessing, planning, developing, and implementing systems and processes to improve reimbursement outcomes.
  • Consult with clients on technical or interim MDS management assistance as needed.
  • Maintain current knowledge of professional standards of clinical care, federal and state statutes, QM measures, and RAI process.
  • Provide high-quality, professional services, including reimbursement optimization, education, research, analysis of healthcare systems and processes, creative problem-solving, and written presentations to clients.
  • Identify training needs and plan and conduct training/in-services as requested.
  • Function within scope of work as defined by the client and maintain client confidentiality and function within HIPAA regulations.
Qualifications
  • Graduate of an accredited college or university with at least a Bachelor's degree in a nursing or therapy discipline and a minimum of five (5) years experience in a clinical position, with 3+ years experience with the RAI process.
  • Must have current and unrestricted RN or Therapist (OT, PT or SLP) License.
  • Must have current RAC-CT certification.
  • Must have critical thinking skills with the ability to make good decisions and exercise sound clinical and professional judgment, with proven knowledge of quality improvement concepts and processes.
  • Demonstrates strong leadership and interpersonal skills.

MDS Solutions is an equal opportunity employer/service provider.

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