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Clinical Reimbursement Specialist - RN

Company: Vi Living
Location: San Jose
Posted on: September 21, 2023

Job Description:

$4,000 Sign-On Bonus $44.14 - $55.18 / hour This is a position that will work as a Clinical Reimbursement Specialist a few days per week and the floor as an RN. Collaborates with the DON, CRM (where applicable) and various disciplines to assist in the completion of the Minimum Data Set (MDS), Resident Assessment Instrument (RAI), and all associated processes. With guidance and oversight from the DON or CRM (where applicable),the CRS ensures completion of the assessment within the timeframe as mandated by federal regulations and company policies. The CRS manages the overall resident assessment process and tracking of all Medicare/Managed Care/Medicaid case mix documents in order to ensureappropriate and optimal reimbursement for services provided within the Care Center. Responsibilities also include assisting with the coordination of resident care planning processesunder the direction of the DON or CRM (where applicable). Clinical Reimbursement Specialist - RN Reviews the clinical records, MD progress notes, therapy and nursing documentation in order to capture all care and services for optimal reimbursement. Ensures that participants in the assessment process complete an accurate and comprehensive assessment. Tracks Medicare/Managed Care Beneficiaries to determine continued and appropriate Medicare eligibility and benefit period by determining skilled level of need. Performs concurrent and ongoing MDS review to ensure appropriate PDPM category is achieved through the capture of appropriate clinical information. Manages the coordination of ICD-10 coding for Medicare and Managed Care billing. Directs the interdisciplinary team process to communicate opportunities to ensure capturing of all care, services, and diagnosis. Coordinates with rehabilitation services Program Director, Corporate Director of Clinical Reimbursement and Central Billing Office as needed to communicate case mix data required for accurate claim billing at month end. Reviews additional document requests by local Medicare Administrative Contractors, insurance carriers or auditors to ensure appropriate documentation is submitted timely for review. Encourages staff to report changes in the resident's status and involves the DON and CRM (where applicable) in addressing concerns. Completes resident assessment protocol documents within RN scope of practice. Assists with the completion of the resident care plan and the care plan conferences per requirements with supervision and guidance from the DON or CRM (where applicable). Provides resident and family education within RN scope of practice as needed. Identifies and reports deviations from safe practice to the DON or CRM (where applicable). Adheres to policies and guidelines of regulatory agencies (i.e. OSHA, CMS). Manages emergency situations based on the Company's safety and disaster policies. Participates in quality assessment/performance improvement activities and audits as assigned and overseen by the DON or CRM (where applicable). Maintains minimum data set competencies and attends annual educational programs. Requirements Education: Graduation from a School for Registered Nursing is required.
Work Experience: Minimum 1 year of previous experience in an MDS/Clinical
Reimbursement Nurse role is preferred.
Licensure / Certification, where required: Current State Licensure as a Registered
Nurse in the state where practicing is required. Current CPR and Automated External
Defibrillator (AED) certifications are required. Current First Aid certification is required
or must be willing and able to become First Aid certified. Food handlers certification,
where required Compensation: $44.14 - $55.18 / hourLocation Address620 Sandhill Road, Palo Alto, California 94304

Keywords: Vi Living, San Jose , Clinical Reimbursement Specialist - RN, Healthcare , San Jose, California

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