Clinical Reimbursement Specialist
6 days ago
Job Summary:
We are seeking a highly skilled Clinical Reimbursement Specialist to join our team. As a key member of our clinical reimbursement team, you will play a crucial role in maximizing utilization and reimbursement through the completion of the MDS, care plan, and care guide process.
About the Role:
The successful candidate will be responsible for coordinating Medicare, Managed Care, and Medicaid activities at the facility. This includes educating administrators and facility staff on innovative procedures to maximize utilization and reimbursement. You will also be responsible for monitoring compliance with company procedures and federal, state, and local regulations.
Essential Functions:
- Education: Provides education and assistance to facilities on Medicare/Medicaid-related areas, including eligibility, certification, coverage, documentation, utilization, and reimbursement.
- Coordination: Interacts with Medicare, Managed Care, and Medicaid claims review units and compliance units to assist facilities in complying with company procedures and federal, state, and local regulations.
- Monitoring: Completes and assesses compliance with Medicare, Managed Care, and Medicaid and third-party payers and company procedures.
- Administration: Establishes and maintains current statistical data associated with the Medicare, Managed Care, and Medicaid programs by region.
- Financial Management: Monitors and identifies utilization issues, establishes systems and programs to maximize utilization and reimbursement, and monitors compliance with third-party policies and procedures for authorizations for payment and provision of services.
- Training: Provides ongoing orientation and training to appropriate facility staff regarding the Medicare, Managed Care, and Medicaid and other contracted third-party payers' programs.
- Meetings: Coordinates, facilitates, and attends meetings.
- Committees: Attends and participates in committees as assigned.
- Staff Development: Attends and participates in training and other learning activities at the facility level.
Required Skills and Qualifications:
- A Registered Nurse in the State of New York with a Bachelor's Degree in nursing is preferred, but not limited to this requirement.
- Two years of experience in Medicare/Medicaid areas in long-term care or clinical training is preferred.
- Excellent communication and teaching skills in both individual and group settings are required.
- Ability to maintain regular attendance and travel, including overnight travel, as required.
- Working knowledge of MDS 3.0, care plans, care guides, and the CMI reimbursement process is necessary.
Benefits:
We offer a competitive salary of $65,000-$85,000 per year, depending on experience, plus benefits and opportunities for professional growth and development.
Location: Medina Center for Rehabilitation
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