Medical Reimbursement Consultant for Senior Care Communities
6 days ago
At Stonegate Senior Living, we are seeking an experienced Clinical Reimbursement Specialist to join our team. As a key member of our clinical team, you will play a crucial role in ensuring the highest quality care and reimbursement for our residents.
About the JobThe Clinical Reimbursement Specialist is responsible for coordinating internal Skilled Nursing Facility operations to ensure compliance with CMS Medicare guidelines, Managed Care case management policy and procedures, and Medicaid reimbursement criteria. This position requires expertise in educating facility staff on Medicaid and performing audits to ensure compliance with government and state rules and regulations.
Key Responsibilities:- Routinely visits assigned facilities to review, monitor, and/or audit the provision of Medicare services.
- Provides dissemination, interpretation, understanding, and application of changes in Medicare, Medicaid, and Managed Care Program policies.
- Develops and implements strategies to improve quality census mix and maximize reimbursement.
- Collaborates with facility teams to ensure accurate and timely completion of MDS data entries.
- Assists in the hiring and mentoring of MDS Coordinators and provides training on computer applications.
To be successful in this role, you will need:
- A current valid RN license in the state of Texas.
- Thorough knowledge of state and federal regulations and standards of care.
- Minimum of three years' experience in long-term care, preferably as a Director of Nursing with Medicare/Medicaid/MDS background.
- Management/Supervisory experience required.
- Strong interpersonal and communication skills.
- Reliable transportation and flexibility to travel.
We offer competitive compensation, health, dental, and vision insurance, company-paid life insurance, holiday pay, paid time off, and employee appreciation events. Our estimated salary for this role is $85,000 - $95,000 per year, based on location and experience.
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