Clinical Reimbursement Specialist
3 days ago
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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