Regional Reimbursement Specialist

2 weeks ago


Columbia, South Carolina, United States SanStone Health & Rehabilitation Full time
Job Title: Regional Reimbursement Specialist

SanStone Health & Rehabilitation is seeking a highly skilled Regional Reimbursement Specialist to provide support, education, and training to MDS Coordinators in our facilities. The ideal candidate will have a strong background in the RAI process, Medicare and Medicaid Case Mix, and a proven track record of ensuring accurate claims and billing.

Key Responsibilities:
  • Provide leadership and oversight to regional and facility staff on the RAI process, Medicare program, and Medicaid Case Mix.
  • Conduct regular monitoring of facility Medicare management and Case-Mix to ensure compliance and accuracy.
  • Collaborate with the Regional Nurse Consultant to provide education and support for the development of systems to address and manage Quality Measures (QM) and the CMS Five Star Rating.
  • Support the development and implementation of program improvement and development efforts related to the RAI, Medicare, and Medicaid programs.
  • Participate in the Quality Assurance Process Improvement Program, identifying and evaluating trends, assisting with Root Cause Analysis, and supporting facility follow-up through appropriate measurement design.
Requirements:
  • Current license as a Registered Nurse issued by the State Board of Nursing.
  • Bachelor's degree or Associate degree in nursing from an accredited college.
  • Minimum 3+ years' experience with the RAI process.
  • Prior multi-facility experience a plus.
  • Strong knowledge of PDPM and State Case Mix Time-weighted Reimbursement payment system.
  • Knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to long-term care.
  • Effective verbal and written English communication skills.
  • Ability to communicate at all levels of the organization and work well within a team environment in support of company objectives.
  • Customer service-oriented with the ability to work well under pressure.
  • Strong attention to detail and accuracy, excellent organizational skills with the ability to prioritize, coordinate, and simultaneously maintain multiple projects with high-level quality and productivity.
  • Ability to work with minimal supervision, take initiative, and make independent decisions.
  • Approachable, flexible, and adaptable to change.
  • Function independently and have flexibility, personal integrity, and the ability to work effectively with employees and vendors.
  • Demonstrate basic to intermediate skills in Microsoft Word, Excel, PowerPoint, and Internet navigation, preferred.
  • High level of professionalism with the ability to maintain confidentiality.
  • Ability to travel.


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