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