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Clinical Reimbursement Specialist
2 months ago
We are looking for a Clinical Reimbursement Specialist (MDS Coordinator) to contribute to our healthcare facility. This role involves collaborating with a team of healthcare professionals to ensure the highest quality of care for our patients. The MDS Coordinator plays a vital role in collecting and analyzing data regarding the physical and mental health of current and prospective residents.
Key Responsibilities:- Evaluate potential Patient Driven Payment Method (PDPM) and associated costs for incoming admissions.
- Engage in the admission process, assessing nursing requirements and determining appropriate reimbursement levels.
- Oversee the MDS process for all residents, ensuring accuracy and compliance.
- Maintain up-to-date knowledge of Medicare regulations, serving as a resource for nursing staff and communicating any changes.
- Track Case Mix Index (CMI) scores to identify potential risks or changes impacting Medicaid reimbursement.
- Ensure timely and accurate submission of Medicare assessments and nursing documentation.
- Support physicians in delivering ongoing patient care.
- Promote the physical, mental, and dietary well-being of patients.
- Communicate any changes in patient health status to the medical team.
- Provide preventive health care recommendations to patients and the interdisciplinary team.
- Participate in health care programs, seminars, and educational opportunities.
- Prior experience as an MDS Coordinator.
- RAC Certification is advantageous.
- Familiarity with Resource Utilization Groups (RUGs), PDPM, and Case Mix Index.
- Valid state Registered Nurse license.
- Strong interpersonal skills to build rapport with patients and staff.
- Exceptional written and verbal communication abilities.
- Capacity to excel in a fast-paced environment.
