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Medicare and Medicaid Coordinator
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We are seeking a highly skilled Clinical Reimbursement Specialist to join our team at Medina Center for Rehabilitation. The successful candidate will be responsible for coordinating Medicare, Managed Care, and Medicaid activities at our facility.
Key Responsibilities- Education and Training: Provide education and assistance to facilities on Medicare/Medicaid-related areas, including eligibility, certification, coverage, documentation, utilization, and reimbursement.
- Coordination and Compliance: Interact 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 and Analysis: Complete and assess compliance with Medicare, Managed Care, and Medicaid programs and third-party payers, establishing systems and programs to correct non-compliance situations.
- Financial Management: Monitor and identify utilization issues, establishing systems and programs to maximize utilization and reimbursement.
- Training and Development: Provide ongoing orientation and training to facility staff regarding Medicare, Managed Care, and Medicaid programs.
- Meetings and Committees: Coordinate, facilitate, and attend meetings, as well as participate in committees as assigned.
- Staff Development: Attend and participate in training and other learning activities at the facility level.
- MDS 3.0 Coordination: Gather data and provide direction to acquire accurate and timely completion of MDS 3.0 as it relates to Medicare, Managed Care, and Medicaid.
- Care Plan Meetings: Chair care plan meetings and conduct them in a thorough manner, capturing accurate information revealed through the completion of the MDS.
- Audit and Compliance: Audit ADL logs and assessments to ensure accurate and timely completion of the MDS assessment tool.
- A Registered Nurse in the State of New York with a Bachelor's Degree in nursing is preferred.
- 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.
- The ability to maintain regular attendance and be available to travel, including overnight travel, as required is necessary.
- The ability to perform all essential job functions, with or without reasonable accommodations, is required.
- A working knowledge of MDS 3.0, care plans, care guides, and the CMI reimbursement process is necessary.
