Clinical Reimbursement Specialist/MDS Coordinator (RN)

About the position

We are seeking a highly organized person with strong time management skills to join our team as a Clinical Reimbursement Specialist who is a registered nurse. In this role you will responsible for overseeing a health center's RAI/Minimum Data Set and insurance authorization/coverage processes. This role does not have weekends, holidays or on-call and is located onsite. If you are a highly motivated individual with a passion for people and a desire to make a difference, we encourage you to apply for this exciting opportunity. We offer competitive compensation, benefits, and professional development opportunities. We would love to meet you!

Responsibilities

• Maintains and actively promotes effective communication with all individuals.
• Maintains a positive image of the entity in the community keeping in alignment with our mission, vision, and values.
• Responsible for on-call services, as assigned.
• Will ensure center adheres to Medicare coverage requirements; such as certification, assessment, and advance beneficiary notice.
• Will oversee the Medicare meeting and provide direction to support process improvement.
• Will oversee and assure accuracy/quality of the MDS/RAI process, including scheduling, completion and content.
• Will be responsible to review 24 hr. report, physician orders, stand up meeting minutes daily, and monitor for any resident MDS/insurance coverage issues.
• Will manage all requirements to authorize coverage & continued stay from HMO, Insurance, and LTC Policies.
• Will maintain a strong working relationship therapy to determine assessment reference dates, insurance coverage criteria, and patient rehabilitative plan of care.
• Performs other duties, as assigned.

Requirements

• Current licensure to practice in Wisconsin as a Registered Nurse.
• AANAC Resident Assessment Coordinator Certification Preferred.
• 4-5 years of experience in Minimum Data Set preferred.
• Ability to navigate and effectively utilize an Electronic Medical Record program.
• Current CPR certification.
• Commitment to quality outcomes and services for all individuals.
• Ability to relate well to all individuals.
• Ability to maintain and protect the confidentiality of information.
• Ability to exercise independent judgment and make sound decisions.
• Ability to adapt to change.

Nice-to-haves

• AANAC Resident Assessment Coordinator Certification

Benefits

• Health, Dental, & Vision Insurance
• Health Saving Account with Potential Company Contributions
• 401(k) with Company Match
• Financial and Retirement Planning at No Charge
• Paid Time Off and Holidays
• Basic Life Insurance & AD&D - Company Paid
• Short and Long Term Disability - Company Paid
• Voluntary Ancillary Coverage
• Referral Bonuses
• Employee Assistance Program