Regional Clinical Reimbursement Specialist
Company: Next Step Healthcare
Location: Woburn
Posted on: March 19, 2023
Job Description:
Next Step Healthcare is seeking an experienced Clinical
Reimbursement Specialist to support our MDS/MMQ teams in
Massachusetts.The Regional Clinical Reimbursement Specialist
provides extensive training, analysis, advice and consultation to
the facilities and teams within his/her area of responsibility.
Ensures compliance with federal and state regulations, as well as
Company policy and procedures regarding state case mix/Medicare and
Managed Care payment systems. Monitors, consults, and makes
effective recommendations for changes and modifications to existing
facility processes, systems, policies, and practices which will
assure efficient, effective and compliant state
Medicaid/Medicare/Managed Care payment performance.Full-time; home
office based position with 3-4 travel days per week covering North
Boston, Central & Western MA.Job Functions include but are not
limited to:
- Provides consultation, training and support concerning the
Medicare, Managed Care and state case mix payment system for the
assigned area.
- Analyzes systems and processes to determine that federal and
state regulations as well as company policies and procedures are
followed. Promotes compliance by performing periodic audits of MDS
assessments, supporting documentation, and other relevant
data.
- Recognizes, advises and promotes facility best practices and
systems for dealing with state case mix/Medicare and Managed Care
payment systems.
- Studies, analyze and reports period over period information and
systems in order to identify trends and deviations from results in
Medicare, Managed Care and State Case Mix Index and takes
appropriate actions.
- Works in conjunction with teams to resolve issues effecting
deviations from expected results. Recommends changes and performs
follow-up to ensure that those recommendations are effectively
implemented and monitored for appropriateness.
- Regularly communicates to management outside the facility on
recommendations made to facility management to ensure proper
implementation and follow-up.
- Serves as a liaison between state and organization related to
the state case-mix process, including electronic submission and
state MDS requirements related to state payment.
- Assists in the recruitment/interview process for MDS and MMQ
vacancies.Qualifications:
- Licensed as a Registered Nurse (RN) in the State of
Massachusetts
- Three to Five years of clinical experience in a long-term care
setting, which includes supervisory, administrative or consultative
capacities.
- Current knowledge of computer technology and systems.
- Ability to work independently with minimal supervision and
guidance.
- Extensive knowledge of MDS and back-up documentation required
and extensive knowledge of state grouper and calculator field
relative to MDS and state payment.
- Extensive knowledge of Medicare reimbursement, RUG IV system,
compliance and eligibility.
- Must be willing and able to travel extensively and maintain a
valid driver's license.We offer competitive compensation and
benefit plans including:
- Vacation, sick and holiday pay
- Medical, Dental, Vision Insurance
- ST/LT Disability Insurance
- Tuition Reimbursement
- Life Insurance
- 401KAt Next Step Healthcare, we know that working in the
healthcare industry is more than just a job - it's a way of life
reserved for the most compassionate, caring, and hard-working
individuals. Are you ready to take the next step in your career?
Apply today.Next Step Healthcare is an equal opportunity employer.
-We embrace diversity and are committed to fostering an inclusive
workplace for all employees. -HPIND123Powered by JazzHR
Keywords: Next Step Healthcare, Boston , Regional Clinical Reimbursement Specialist, Healthcare , Woburn, Massachusetts
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