Long-Term Care Reimbursement Specialist

4 weeks ago


Johnson City, New York, United States Vestracare Full time
Job Summary:

Vestracare seeks an experienced Long-Term Care Reimbursement Specialist to join our team. In this role, you will play a critical part in maximizing reimbursement and utilization through effective coordination with Medicare, Managed Care, and Medicaid activities.

Main Responsibilities:
  • MDS LPN Coordination: Collaborate with Registered Nurses to ensure seamless execution of MDS processes, care plans, and care guides.
  • Education and Support: Provide training and guidance to facility staff on innovative procedures for optimizing reimbursement and utilization.
  • Certification and Compliance: Assist facilities with initial certification procedures, address problem areas, and interact with claims review units to maintain compliance with company protocols and federal, state, and local regulations.
  • Denial Review and Preparation: Help prepare and review denied claims or administrative record reviews by outside intermediaries.
Requirements:
  • Experience: Minimum 2 years of long-term care experience; preferred 4 years.
  • Licensure: Current, unrestricted licensure as a NYS Licensed Practical Nurse (LPN).
  • Certification: RAC-CT certification is preferred.
  • Skills: Excellent time management, organization, leadership, communication, and problem-solving skills.

Salary: $29 - $30 per hour, dependent upon experience



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