Job Information
Mt. Greylock Extended Care Facility CLINICAL REIMBURSEMENT COORDINATOR in Pittsfield, Massachusetts
- 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. Salary starting at \$45.00 per hour Qualifications Education Required Associates or better in Nursing or related field. Experience Preferred 1 year: Do you have Clinical Reimbursement Coordination experience? Licenses & Certifications Preferred REGISTERED NURSE