Must have Long-Term Care/Nursing Home Experience & you must have RAC-CT
Summary: The Clinical Reimbursement and Quality Management plays a vital role in ensuring accurate reimbursement for services provided to residents, while simultaneously improving the quality of care and ensuring compliance with regulatory standards.
Clinical Reimbursement:
- Documentation: Review and analyze resident documentation to ensure accuracy and completeness for reimbursement purposes, including Minimum Data Set (MDS) assessments and other relevant documentation.
- Coding and Billing: Assist in the accurate coding and billing of resident care services to maximize reimbursement.
- Claim Review: Review and analyze submitted claims for accuracy and identify potential areas for improvement or appeal.
- Regulatory Compliance: Stay up-to-date on current reimbursement regulations and guidelines (e.g., Medicare, Medicaid) and ensure compliance.
- Data Analysis: Analyze reimbursement data to identify trends and opportunities for improvement in care and documentation practices.
- Quality Management:
- Quality Improvement: Participate in the development and implementation of quality improvement initiatives to enhance resident care and outcomes.
- Data Collection and Analysis: Collect, analyze, and report on quality data to identify areas for improvement and track performance.
- Performance Improvement Projects: Lead or participate in quality improvement projects to address specific issues or concerns.
- Policy and Procedure Development: Assist in the development and implementation of policies and procedures related to quality and reimbursement.
- Regulatory Compliance: Ensure compliance with relevant regulations and standards related to quality of care and resident safety.
- Documentation: Review and ensure the accuracy and completeness of resident records, including assessments, care plans, and progress notes.
- Communication: Serve as a liaison between nursing staff, residents, families, and other healthcare professionals to ensure effective communication and coordination of care.
- Other Responsibilities:
- Training: Provide training to staff on documentation, coding, billing, and quality improvement processes.
- Audits: Assist with internal and external audits related to quality and reimbursement.
- Problem Solving: Identify and resolve issues related to reimbursement and quality of care
Qualifications:
Bachelor of Science in Nursing (BSN).
Certification as a PRI Assessor preferred.
Successful completion of a MDS training course.
- Experience: Minimum 3 years MDS experience and a minimum of 2-3 years of clinical nursing experience, with experience in long-term care or related healthcare setting preferred.
- Knowledge: Strong understanding of nursing care, documentation, coding, billing, and reimbursement regulations.
- Skills: Excellent communication, interpersonal, and organizational skills.
- Other: Ability to work independently and as part of a team, attention to detail, and ability to prioritize tasks.
Job Type: Full-time
Pay: $135,000.00 per year
Work Location: In person
