Regional Clinical Reimbursement Specialist

Job Description

> REF:#bee863c81da44d25 Springpoint is seeking an experienced Regional Clinical Reimbursement Specialist to join our team!

The Regional Clinical Reimbursement Specialist is responsible for regulatory compliance and quality improvement efforts to attain appropriate Medicare or Managed Care reimbursement, and integrates information from all necessary disciplines to maintain accuracy and compliance with the MDS process. This position reports to the Vice President of Health Services, and works collaboratively with facility team members.

Responsibilities:

Ensures compliance with Federal and State regulations and company policies that govern Medicare and state payment systems.
Review accuracy of ICD-10 Coding
Provide oversight of the RAI process and policies
Audit MDS for accuracy and timeliness
Coordinate and provide education to the MDS Coordinators and Interdisciplinary team related to the RAI process, regulatory changes and reimbursement
Auditing of Springpoint Communities compliance with regulations and policies
Audit accuracy of PBJ data prior to submission
Provide temporary MDS completion support at the communities
Assure care planning and care conferencing is taking place according to the state and regulatory guidelines
80% of time will be spent in the communities providing supervision, clinical expertise, ensuring communication and monitoring the overall operation of reimbursement department
Provide in-service training and orientation to facility staff regarding the MDS, ADL’s and accuracy at the communities.
Conducts concurrent MDS reviews, they assure the achievement of maximum allowable PDPM categories allowed by law

Education and Experience:

Graduate of an approved Registered Nurse Program required.
Multistate Registered Nurse licensure required.
RNAC Certification required.
Prior experience in Medicare reimbursement and/or MDS experience required.

Comprehensive Benefits Package Including:

Medical/Dental/Vision/RX Plans
401(k) with Company Match
PTO and Holidays
Flexible Spending Accounts
Supplemental Life Insurance
Employee Bonus Referral Program
Employee Assistance Program
Wellness Program
Tuition Reimbursement

Salary: $125,000.00 / yr