CLINICAL REIMBURSEMENT SPECIALIST at Liberty Health – Wilmington, North Carolina

Liberty Cares With Compassion

At Liberty Healthcare and Rehabilitation Services, we promote a challenging, but rewarding opportunity in a caring environment.

We are currently seeking an experienced:

CLINICAL REIMBURSEMENT SPECIALIST

JOB SUMMARY:

• Consults with assigned nursing facilities on a routine basis.
• Monitors Medicaid Case Mix, Patient Driven Payment Model Metrics, Managed Care metrics and other payment metrics as indicated.
• Facilities facility reviews to ensure that accurate coding of the MDS is completed in order to ensure maximum allowable reimbursement.
• Conducts targeted site reviews for assigned facilities at least a semiannual basis. These reviews will include validating accuracy of coding and supportive documentation for various payer types.
• Provides facility with a typed report of visits that provides a score indicating compliance with expectations.
• Monitors the facility’s compliance with the standard policies and procedures implemented by Liberty Healthcare-Long Term Care.
• Responds to questions by facility staff concerning the policies and procedures and RAI process.
• Reviews and updates current policies and procedures according to federal/state requirements and current standards of practice.
• Attends educational sessions pertinent to Long Term Care.
• Assist with MDS as needed.
• Works with other departments as needed to improve Quality of Care or to improve the process in which we conduct business.
• Works with pharmacy, medical supply company and other vendors to evaluate MCA services provided in the facilities.
• Assist new facilities in the implementation of Policies and Procedures.
• Assist with orientation of new MDS Coordinators when needed.
• Coordinates or participates in education sessions for the facilities such as DON meetings and new policy and procedure training.
• Review MDS scheduler to ensure that facility MDS is current.

JOB REQUIREMENTS:

• Must be a High School graduate
• Must be a Registered Nurse, graduated from an accredited School of Nursing, and have a current, valid RN license from the Board of Nursing in the state of assignment and submit proof of license renewal every other year.
• Willing to serve as MDS coordinator in a facility during vacancies in that position.
• Dependable, flexible, and able to work and cooperate well with all nursing personnel, other departments and have understanding, patience, and tact in working with patients, families, doctors, and others.
• Ability to make decisions regarding nursing problems.
• Able to teach, instruct and direct orientation, continuing education, in-service as needed.
• Must read, know, and follow personnel, department and Facility policies and procedures and adhere to local, state, and federal requirements.
• Must have working knowledge of the rules and regulations related to Long Term Care.
• Must have Long Term Care experience.
• Extensive traveling to include overnight stays
• Must have a neat professional appearance at all times.