Medicare & Medicaid Program Manager

7 days ago


Johnson City, New York, United States Living Legends Health Full time
Overview:
We are seeking a highly skilled Clinical Reimbursement Specialist to join our team at Living Legends Health. As a key member of our operations team, you will play a critical role in ensuring that our facilities comply with Medicare, Managed Care, and Medicaid regulations while driving improvements in reimbursement and optimizing resource allocation. If you are passionate about delivering exceptional patient care and have a strong background in reimbursement and quality measures, we encourage you to apply for this challenging and rewarding role.

About the Role:
As a Clinical Reimbursement Specialist, you will work closely with our facilities to educate administrators and staff on innovative procedures to enhance utilization and reimbursement. You will also interact with external stakeholders to ensure that our facilities adhere to company procedures and regulatory requirements. Your expertise in PDPM reviews, MDS completion, and ICD-10 coding will enable you to drive improvements in reimbursement and optimize resource allocation.

Key Responsibilities:
• Conduct PDPM reviews upon admission or re-admission as indicated
• Review MDS completion for Medicare A MDS' for compliance and accuracy
• Gather documentation for CMS audit requests and other audits as needed
• Participate in MDS Integrity reviews as required
• Assist in reviewing and maintaining current statistical data associated with the Medicare, Managed Care, and Medicaid programs by region
• Monitor and identify utilization issues, establishing systems and programs to maximize utilization and reimbursement
• Provide ongoing orientation and training to appropriate facility staff regarding Medicare, Managed Care, and Medicaid and other contracted third-party payers
• Educate staff on changes in any reimbursement program

Requirements:
• Minimum 2 years of Long-Term Care experience
• NYS Licensed Practical Nurse (LPN) current, unrestricted licensure
• RAC-CT certification preferred
• Excellent communication, interpersonal, and problem-solving skills
• Ability to effectively manage multiple priorities and meet deadlines
• Strong analytical and organizational skills
• In-depth knowledge of regulatory requirements and standards of care in long-term care settings

Salary: $29-$32 per hour, dependent on experience.

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