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Geriatric Nursing Reimbursement Specialist
2 months ago
Job Summary:
The Clinical Reimbursement Manager is responsible for coordinating, managing, and ensuring the accuracy and capitalization of Masonicare's reimbursement from its payor sources. This role is responsible for the coordination of the Resident Assessment Instrument (RAI) process.
Key Responsibilities:
- Manages the facility's RAI processes to capture accurate resident-related data and works with all resident service departments involved in the RAI process to maximize residents' full reimbursement potential.
- Provides and ensures accurate documentation of all services to maximize accurate reimbursement from all payor sources.
- Completes all performance reviews with staff and hires new staff.
- Selects, trains, orients, and assigns department staff. Develops standards of performance, evaluates performance, and initiates or makes staff recommendations.
- Reviews facility quality indicators, assisting as needed with identifying strengths and weaknesses of data and how it relates to facility care practices.
- Manages patients' Medicare benefits by communicating skilled needs to patients, families, and interdisciplinary care teams.
- Organizes and participates in daily Medicare meetings, utilization reviews, and monthly end-of-close meetings.
- Assists with Medicare denial claims/reviews when needed by the billing office.
- Keeps abreast of changes in Medicare, Medicaid, and managed care areas and MDS/RAI processes through journal reading, outside in-services, and other sources.
- Continually upgrades and makes changes in the job area to ensure that departments meet the needs of the changing market, federal, and/or state mandates.
- Participates in and attends all mandatory Masonicare in-services and departmental staff and in-service meetings.
Requirements:
- Requires a Registered Nurse with a current Connecticut State license and a BSN or MSN graduate degree from an accredited school of nursing.
- Requires at least 3-5 years of experience in geriatric nursing.
- Requires at least two (2) years of experience with federal Medicare/Medicaid and managed care reimbursement systems with a thorough working knowledge of the MDS and RAI process.
- Requires a working knowledge of OBRA regulations as they relate to Skilled Nursing facilities.
- Requires strong working knowledge of statistics, data collection, analysis, and presentation.
Certifications, Licenses, and Registrations:
- Current Connecticut State RN licensure required.
