Clinical Reimbursement Specialist

7 days ago


Santa Ana, California, United States St. Edna Subacute & Rehab Center Full time

Job Summary:

We are seeking a highly skilled Clinical Reimbursement Specialist to join our team at St. Edna Subacute & Rehab Center. As a key member of our clinical operations team, you will play a vital role in ensuring the accurate and timely reimbursement for our Medicare and Medi-Cal residents.

About the Role:

The Clinical Reimbursement Specialist will provide support and assistance with the clinical and financial management of our residents. This includes providing education and training to MDS Coordinators and Interdisciplinary Team (IDT) members on MDS and Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) guidelines.

Responsibilities:

  • Collaborate with the Chief Clinical/Nursing Officer, Senior Vice President of Clinical Services, Nurse Resource Consultants, and other Clinical Resource Consultants
  • Provide continuous education & training on RAI/MDS Process, Medicare/PPS Management & Clinical Reimbursement, and other clinical education as applicable
  • Conduct on-site center visits to review RAI/MDS Process, Medicare/PPS Management, and Quality Measure (QM) reports for accuracy and compliance
  • Conduct medical record reviews for RAI/MDS accuracy and complete required facility and/or departmental reports
  • Participate in facility Care Management and Triple Check Meetings to ensure compliance with Medicare/PPS Management related policies
  • Coordinate monthly Medicare Audits and quarterly Care Management Quality Assurance reviews for assigned facilities
  • Act as an educational resource to the MDS Coordinator, Director of Nursing, IDT, etc., based on facility visit/record review findings and/or trends
  • Liaise with ancillary providers to establish consistent standards of RAI/MDS and Medicare utilization

Administrative Responsibilities:

  • Attend and participate in all assigned meetings, training, education, and in-services as required
  • Furnish written reports identifying recommendations, PDPM, QM, and MDS changes at the conclusion of each center review
  • Follow up on previous visit's recommendations, PDPM, QM, and MDS changes, and document these changes
  • Meet at least monthly with the Resource Consultant/Clinical Operations Team to review facility/regional trends
  • Attend periodic meetings with the VP of Clinical Reimbursement Program
  • Conduct exit interviews with Administrator, Director of Nurses, and MDS Coordinator to review report contents

Consumer Service:

  • Present a professional image through dress, behavior, and speech
  • Adhere to Company standards for resolving consumer concerns
  • Ensure all consumer/resident rights are protected

Benefits:

  • $75,000 - $90,000 per year
  • Competitive pay
  • Health Benefits - Medical, dental, and vision coverages with a substantial company contribution (voluntary supplemental plan options available)
  • 401(k) with discretionary company match annually
  • Company-paid Basic Life and disability insurance (buy-up options available)
  • Paid Time Off (Vacation, Sick, Holiday)
  • Employee Assistance program
  • Tuition Assistance and Professional Enhancement Funds
  • Bene-Hub employee-sponsored discount programs and more...


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