Clinical Reimbursement Specialist

3 days ago


Windsor, Connecticut, United States Windsor Health & Rehabilitation Center LLC Full time
Job Description

We are seeking an experienced MDS Coordinator or Clinical Reimbursement Coordinator to join our team at Windsor Health & Rehabilitation Center LLC. The ideal candidate will possess excellent clinical and analytical skills, with a strong ability to communicate effectively with patients and healthcare professionals.

Key Responsibilities:

  • Determine potential Patient Driven Payment Method (PDPM) and associated expenses for prospective residents
  • Participate in the admission process, assessing nursing needs and reimbursement levels
  • Ensure accuracy of the Minimum Data Set (MDS) process for all residents
  • Maintain current knowledge of Medicare criteria and regulations, serving as a resource for nursing staff
  • Monitor Case Mix Index (CMI) scores and identify potential risks to Medicaid reimbursement
  • Verify timely submission of Medicare assessments and nursing documentation

Requirements:

  • Previous experience as an MDS coordinator or similar role
  • RAC Certification is a plus
  • Familiarity with Resource Utilization Groups (RUGs), PDPM, and Case Mix index
  • Current and valid state Registered Nurse license
  • Excellent written and verbal communication skills
  • Ability to thrive in a fast-paced environment

Estimated Salary: $65,000 - $85,000 per year, depending on experience and qualifications



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