Clinical Reimbursement Specialist - MDS
Company: ProMedica Senior Care
Posted on: September 24, 2022
ProMedica Senior Care is hiring for a Clinicial Reimbursement
Specialist to cover our California region! The Clinical
Reimbursement Specialist is responsible to review Medicare/Medicaid
documentation to assist nursing centers in completing MDS to ensure
appropriate levels of Medicare and/or Medicaid reimbursement. Works
with RDOs, Administrators, and facility staff in
training/consulting on traditional Medicare A coverage,
documentation, and eligibility. As part of a regional team (MRBS,
RRM, CMS), assists with monitoring medical records requests for M2
and Managed Medicaid payers to ensure they are tracked and
responded to in a timely manner. This role will cover skilled
nursing facilities in the California Region -and candidates must
live in that area. Responsibilities:
- Monitors that facilities follow Medicare/Medicaid regulatory
and HCR ManorCare guidelines.
- Remains abreast of regulatory change for Medicare/Medicaid
reimbursement and communicates necessary information to appropriate
- Reviews MDS documentation for accuracy and appropriateness
- Monitors and assists with validation of Quality Measures report
for accuracy of MDS coding.
- Assists with developing and presenting training materials for
MDS training sessions. .
- Participates in interviews of DCD and MDS Coordinators.
- Performs audits per company standards and policies to ensure
appropriate levels of reimbursement.
- Monitors Corporate Compliance policies and notifies appropriate
facility, regional, divisional, and corporate staff as needed.
- Collaborates with corporate and/or facility staff related to
denial issues affected by the MDS.
- Collaborates with the facility to keep them informed of new
developments for Federal and State payment systems.
- Coaches facility ADNS, Administrators, and other staff as to
proper procedures for M2 medical records requests, and Part A ADRs
- Makes recommendations regarding eligibility and coverage for
Medicare Part A.
- Monitors M2 (Medicare, Managed Care) and Managed Medicaid
records requests, with the regional team, to ensure they are
tracked and responded to in a timely manner.
000 - California, any location
Graduate of an approved Registered Nurse program and RN licensed in
the state of practice required.
Minimum of 2 years of nursing experience in a Skilled Nursing
Facility preferred. Excellent knowledge of Case-Mix, the Federal
Medicare PPS process, and Medicaid reimbursement, as required.
Thorough understanding of the Quality Indicator process. Knowledge
of the OBRA regulations and Minimum Data Set. Knowledge of the care
Keywords: ProMedica Senior Care, Danville , Clinical Reimbursement Specialist - MDS, Other , Danville, California
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