CLINICAL REIMBURSEMENT COORDINATOR-RN
📋 Role Overview & Responsibilities
Perform independent and/or suggested affiliate level, clinical and financial audits as warranted. Identify and assist with educational opportunities through audit, tracking, trending, and analyzing relevant patient data with supervisor guidance and support. Strategic planning as relates to ARDs to optimize appropriate revenue systems. Ensure IDT compliance with state/federal requirements and timeframes related to MDS, billing and care planning. Provide high level interpretation of revenue related data as requested. Identify revenue related risks associated with missing, irrelevant, erroneous clinical documentation. Assist with action plans related to such risk. Assist with orientation and education for CRCs and other IDT members as relates to MDS and/or reimbursement processes. Provide ongoing education and communication with IDT as relates to current state and federal regulation systems driven by the MDS. Review clinical charts to determine skilled need and assist with determining appropriate Length of Stay. Attest to completion of MDS at section Z. Sign MDS completion for any LPNs in the department. Develop and revise care plans as per facility protocol. Attend/Lead CP meetings per facility protocol. Conduct daily, weekly, monthly meetings related to Revenue. (Daily REV, Wkly MRA/CMI, Monthly Triple check) Ensure the timeliness of managed care updates. Assist with maintenance, risk and education related to 5 STAR Quality Measures/Value Based Purchasing, and Quality Reporting programs. Provide information as requested for Additional Documentation Request (ADR). Other related duties as assigned.
Qualifications
MA licensed nurse with 3+ years reimbursement or similar experience in the LTC industry. Computer literacy (Word, Excel, Power Point, Outlook). Experience with current EMR (NTT) software a plus. Evidence of effective written, verbal, and technological communication. Demonstrates excellent organization, communication, and presentation skills. Deadline driven, detail-oriented individual with strong analytical capabilities. Working knowledge of state and federal regulations governing the MDS and billing processes within a nursing facility. (CMI/PDPM/Managed care, QRP/VBP) Ability to communicate with and elicit support from other IDT members at the affiliate level. Ability to apply knowledge in state specific Medicaid and Medicare CMI/PDPM methodologies. Exhibits independent and self-directed work ethic. Must exhibit excellent interpersonal relations, time management, family and customer relations and job knowledge. Must be able to read, write, speak, and understand the English language.
Education
Graduate of accredited RN Program required
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This position is located in Pittsfield, MA with potential relocation and sponsorship assistance depending on candidate qualifications.
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