Registered Nurse - Traveling Clinical Reimbursement Director (MDS)
Company: Consulting Support Services
Location: Saint Petersburg
Posted on: November 19, 2021
The Clinical Reimbursement Director is responsible for the
coordination of the "Resident Assessment Instrument" process to
ensure accurate and timely completion of resident assessments in
accordance with Medicare, Medicaid, OBRA and other payor program
ESSENTIAL DUTIES AND RESPONSIBILITIES:
--- Manages Medicare Part A certification process.
--- Performs ongoing evaluations from pre-admission through
discharge to ensure an appropriate reimbursement level for each
resident. Evaluates care to ensure that services and products match
--- Reviews medical records, care plans, charting to ensure
documentation supports care provided and reimbursement level.
--- Monitors facility practice to ensure compliance with guidelines
for participation in Medicare, Medicaid and other benefit programs.
Initiates action needed to ensure compliance.
--- Participates in quad check prior to release of claims. Tracks
and reviews all claim denials to identify problems.
--- Assists in preparation and timely submission of any additional
development requests, reconsiderations and administrative law judge
--- Review state MDS validation reports to identify issues and or
processes to ensure accuracy of submitted MDS's.
--- Responsible for evaluating and providing education,
intervention and support for Medicare, PPS, RAI, state specific and
special contract reimbursement.
--- Manage the overall process of reimbursement for the
--- Track all Medicare/Medicaid case-mix documents in order to
assure appropriate reimbursement for services provided within the
--- Other duties as assigned.
--- Participates in the pre-admission process to ensure essential
information needed for MDS/Case mix optimization is obtained from
the referral source.
--- Works in collaboration with Rehab Program Coordinator to ensure
the most appropriate assessment reference date is utilized for
--- Lead and manage Clinical Reimbursement Specialist(s) in a
matrix Management environment.
--- Performs modifications of assessments in accordance with CMS
--- Other duties as assigned.
--- Knowledge and understanding of regulatory processes (Federal,
and/or State Regulations)
--- Knowledge of the RAI Regulations
--- Knowledge of principles and processes for providing customer
service. This includes customer needs assessment, meeting quality
standards for services, and evaluation of customer
--- Effective verbal and written communication skills
--- Understanding written sentences and paragraphs in work related
--- Actively looking for ways to help people.
--- Communicating effectively in writing as appropriate for the
needs of the audience.
--- Ability to work in a "Matrix" management environment
--- The ability to listen to and understand information and ideas
presented through spoken words and sentences.
--- Ability to relate positively, effectively, and appropriately
with residents, families, community members, volunteers, and other
facility staff. Possess special interest in working with long-term
care residents and the elderly.
EDUCATION, EXPERIENCE, and TRAINING
--- Computer literacy skills (Microsoft Outlook, Microsoft Office,
--- High School Diploma required
--- One to three years of professional experience and/or training;
or equivalent combination of education and experience.
CERTIFICATES, LICENSES, REGISTRATIONS
--- Licensed RN
--- CPR certification
We are an Equal Opportunity Employer and Drug Free Work Place
Keywords: Consulting Support Services, St. Petersburg , Registered Nurse - Traveling Clinical Reimbursement Director (MDS), Executive , Saint Petersburg, Florida
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