Job Description

12136 W Bayaud Ave, Lakewood, CO 80228, USA Req #2009
Wednesday, March 3, 2021

Clinical Reimbursement Specialist - Corporate


The primary responsibility of the Clinical Reimbursement Specialist is to providemulti-site regional remote and onsite direction, education, consultation, andservice regarding clinical reimbursement systems within Vivage managed homesand other contracted projects.  

This position requires an expertise in the Resident Assessment 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, ancillarymanagement, quality assurance, utilization management including insurance carecoordination 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 strongworking knowledge of the Resident Assessment Instrument (RAI) Manual as well ascomplete the required courses for credentialing through the AmericanAssociation of Nurse Assessment Coordinators and maintain certificationthereafter.  

·        Supports quality careand fiscal responsibility through comprehensive MDS compliance and supportservices.

·        Demonstrates current knowledgeof Medicare/Medicaid and managed care insurance reimbursement procedures,contracts, clinical resource utilization and/or case management. 

·        Regularly inspects andobserves MDS and related practices for compliance with standards andregulations 

·        Monitors and facilitatesstrategies for Quality Improvement related to Quality Indicators andappropriate data collection, metrics and benchmarks

·        May assume the role ofinterim MDS Coordinator, as needed.  

·        Routine travel toperform on-site support  

·        Must have basiccomputer operation and typing skills for efficient data input; must be able tonavigate touchscreen computers and be able to generate comprehensive audit andeducational reports for remote and onsite visits.

·        Must have knowledge ofoffice machines and equipment.

·        Must be able to read,write, speak and understand the English language.

·        Ability to makeindependent decisions when circumstances warrant such action.

·        Must possess theability to deal tactfully when personnel, residents, family members, visitors,government agencies/personnel and the general public.

·        Knowledgeable ofnursing and medical practices and procedures as well as regulations andguidelines that pertain to long term care.

·        Must have patience andenthusiasm, as well as, the willingness and ability to handle difficultresidents.

·        Open to new ideas andbe willing to incorporate them into practice 


·        Graduated from anaccredited school of nursing; current RN license in the State of Colorado.

·        AANAC RAC-CT preferredor able to obtain within 3 months of hire.   

·        Must have as aminimum, five (5) years experience in an administrative supervisory capacity inskilled nursing facility with a minimum of three (3) years experience MDSexperience.

·        CASPER  siteproficiency strongly recommended

·        Previous multi-site MDSconsulting preferred.   


Vivage is an EqualOpportunity Employer


Other details

  • Pay Type Salary

Application Instructions

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