Clinical Reimbursement - Clinical Reimbursement Specialist
Are you an individual who takes responsibility and follows through on details?
Do you like to collaborate and work as part of a team?
Are you naturally good at making connections with people?
Does managing multiple priorities excite you?
At Vivage, we’re recognized as a national leader driving high quality service innovation for seniors and value for our investors. "Vivage" means "celebrating aging" inspiring our focus to create innovative and customer-driven models filled with personalized and meaningful living experiences.
We are a senior health care, solution driven company which provides right care.. right place..right time. Our Mission, Vision and Pillars of Commitment have come from our collective personal awareness and professional dedication to the importance of each person we serve, each employee we work with, and each business partner we have. At Vivage we bridge today’s healthcare opportunities with innovative strategies and solutions.
Engaging Culture ~ Competitive Pay ~ Growth Opportunities ~ Great Benefits ~ Family Environment ~ Payactiv
OVERVIEW OF THE ROLE
The primary responsibility of the Clinical Reimbursement Specialist is to provide multi-site regional remote and onsite direction, education, consultation, and service regarding clinical reimbursement systems within Vivage managed homes and other contracted projects.
This position requires an expertise in the Resident Assement Instrument (RAI). Responsibility includes monitoring accurate and timely completion of all resident assessments through the MDS process including Medicare, Medicaid case mix documents in order to assure appropriate reimbursement for services provided within the organization. Must possess knowledge of billing, cost containment strategies, ancillary management, quality assurance, utilization management including insurance care coordination following the current federal, state and local standards, guidelines and regulations that govern long term care.
Incumbent is delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties to ensure the highest clinically appropriate reimbursement for services which are provided within the Center.
Maintains strong working knowledge of the Resident Assessment Instrument (RAI) Manual as well as complete the required courses for credentialing through the American Association of Nurse Assessment Coordinators and maintain certification thereafter.
Supports quality care and fiscal responsibility through comprehensive MDS compliance and support services.
Demonstrates current knowledge of Medicare/Medicaid and managed care insurance reimbursement procedures, contracts, clinical resource utilization and/or case management.
- Regularly inspects and observes MDS and related practices for compliance with standards and regulations
- Monitors and facilitates strategies for Quality Improvement related to Quality Indicators and appropriate data collection, metrics and benchmarks
- May assume the role of interim MDS Coordinator, as needed.
- Routine travel to perform on-site support
Must have basic computer operation and typing skills for efficient data input; must be able to navigate touchscreen computers and be able to generate comprehensive audit and educational reports for remote and onsite visits.
Must have knowledge of office machines and equipment.
Must be able to read, write, speak and understand the English language.
Ability to make independent decisions when circumstances warrant such action.
Must possess the ability to deal tactfully when personnel, residents, family members, visitors, government agencies/personnel and the general public.
Knowledgeable of nursing and medical practices and procedures as well as regulations and guidelines that pertain to long term care.
Must have patience and enthusiasm, as well as, the willingness and ability to handle difficult residents.
Open to new ideas and be willing to incorporate them into practice
EDUCATION AND EXPERIENCE:
Graduated from an accredited school of nursing; current RN license in the State of Colorado.
- AANAC RAC-CT preferrred or able to obtain within 3 months of hire.
- Must have as a minimum, five (5) years experience in an administrative supervisory capacity in skilled nursing facility with a minimum of three (3) years experience MDS experience.
- CASPER site proficiency strongly recommended
- Previous multi-site MDS consulting preferred.
Vivage is an Equal Opportunity Employer
- Pay Type Salary
- Min Hiring Rate $80,000.00
- Max Hiring Rate $95,000.00