Top 86 Clinical specialist Jobs in Orlando, Fl

Clinical Reimbursement Specialist RN/LPN
Terrace of St. Cloud —Saint Cloud, FL
- $90,000 - $100,000 a year
- Full-time
- Nursing
- Skilled nursing facility
- RN License
Quick Apply
8d
Clinical Documentation Specialist III
AdventHealth Winter Garden —Winter Garden, FL
- $72,786.83 - $135,385.27 a year
- Full-time
- Background check
- Nursing
- Medicine
- Paid parental leave
- Disability insurance
5d
Clinical Documentation Specialist II
AdventHealth Kissimmee —Kissimmee, FL
- $66,170.74 - $123,073.07 a year
- Full-time
- Background check
- Nursing
- Medicine
- Paid parental leave
- Disability insurance
5d
Clinical Documentation Integrity Specialist
AdventHealth Minneola —Minneola, FL
- $72,786.83 - $135,385.27 a year
- Full-time
- Background check
- Nursing
- Medicine
- Paid parental leave
- Disability insurance
5d
Clinical Quality Specialist - BSN - Surgery Area - Preferred Experience
Orlando Health —Orlando, FL
- Full-time
- Nursing
- Surgery
- RN License
Clinical Specialist CRM - Orlando
Medtronic —Orlando, FL
- $72,000 - $90,000 a year
- Weekends as needed
- Remote
- Inventory management
- Computer literacy
- Mid-level
- Health savings account
- Employee stock purchase plan
Clinical Nurse Specialist RN Operations Quality Improvement
AdventHealth Orlando —Orlando, FL
- $91,313.86 - $169,845.73 a year
- Full-time
- Microsoft Word
- Background check
- CPR Certification
- Paid parental leave
- Disability insurance
Clinical Donor Program Specialist
AdventHealth Orlando —Orlando, FL
- $66,170.74 - $123,073.07 a year
- Weekends as needed
- Background check
- Nursing
- Marketing
- Mileage reimbursement
- Paid parental leave
8d
Principal Clinical Specialist
Abbott Laboratories —Orlando, FL
- $86,700 - $173,300 a year
- Full-time
- 6 years
- Senior level
- Health insurance
- Tuition reimbursement
Clinical Quality Specialist II
Orlando Health —Orlando, FL
- Full-time
- Nursing
- RN License
- 5 years
- Benefits from day one
Home Health Clinical Review Specialist (Part-Time/Weekends)
Pinnacle Home Care Inc. —Orlando, FL
- Part-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Referral program
Quick Apply
Clinical Specialist
ASAHI INTECC USA INC —Orlando, FL
- Full-time
- Remote
- Clean driving record
- Mid-level
- Clinic
8d
Clinical Regulatory Specialist RN Waterford Lakes Free-Standing ER
AdventHealth Waterford Lakes ER —Orlando, FL
- $31.53 - $52.24 an hour
- Full-time
- Background check
- Nursing
- RN License
- Paid parental leave
- Disability insurance
Clinical Quality Specialist II
Millennium Healthcare Management Serv LLC —Oviedo, FL
- $19.00 - $28.50 an hour
- Full-time
- Customer service
- Mid-level
- Communication skills
- Paid holidays
- Disability insurance
Quick Apply
3d
Clinical Regulatory Specialist RN Flamingo Crossing Free-standing ER
AdventHealth ER at Flamingo Crossings Town Center —Winter Garden, FL
- $31.53 - $52.24 an hour
- Nights as needed
- Microsoft Word
- Background check
- CPR Certification
- Paid parental leave
- Disability insurance
5d
Clinical Oncology Specialist, Head & Neck
Natera —Orlando, FL
- $190,000 - $225,000 a year
- Remote
- Bachelor's degree
- Travel
- Senior level
- Commuter assistance
- Health insurance
Clinical Regulatory Specialist RN Emergency Department
AdventHealth East Orlando —Orlando, FL
- $31.53 - $52.24 an hour
- Full-time
- Background check
- CPR Certification
- Nursing
- Paid parental leave
- Disability insurance
Imaging Clinical Applications Specialist, Orlando - Bracco Diagnostics Inc.
Bracco —Orlando, FL
- Weekends as needed
- Background check
- Hospital
- Bachelor of Science
Navigator - Non-Clinical - Neurosurgery - FT - Days - MPG
Memorial Healthcare System —Florida
- Full-time
- Customer service
- BLS Certification
- Mid-level
3d
Clinical Billing Specialist - Medicaid
SHCM Corporate —Casselberry, FL
- Ability to walk for extended periods
- HIPAA
- Mid-level
Quick Apply
2d

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Clinical Reimbursement Specialist RN/LPN

Terrace of St. Cloud -
Saint Cloud, FL

Quick Apply

Job Details

Full-time
$90,000 - $100,000 a year
8 days ago

Qualifications

Long-term care regulations
Medicare
Medical software
Patient assessment
Spreadsheets
CMS
Healthcare documentation compliance audits
Medicare regulations
Clinical documentation
Centers for Medicare & Medicaid Services (CMS) billing regulations
Medicaid regulations
Medicaid
Clinical documentation improvement
Productivity software
Quality audits
Clinical documentation standards
Care plans

Full Job Description

Position Summary

The Clinical Reimbursement Specialist is an on-site facility resource responsible for coordinating and monitoring the Minimum Data Set (MDS), resident assessment, care-planning, skilled coverage, and reimbursement processes. The position works directly with the Administrator, Director of Nursing, MDS team, therapy, Business Office, medical providers, and interdisciplinary team to ensure that resident assessments are accurate, timely, clinically supported, and compliant with Medicare, Medicaid, managed care, the Patient-Driven Payment Model (PDPM), and applicable federal and state requirements.

The specialist maintains daily visibility into facility admissions, payer changes, clinical changes, assessment schedules, documentation quality, authorization requirements, and reimbursement risks. The role supports appropriate reimbursement only when it is fully supported by the resident’s condition, services provided, and the medical record.

Essential Duties and Responsibilities

1. MDS and Assessment Coordination

Maintain the facility MDS assessment calendar and monitor all assessment reference dates, completion dates, transmission deadlines, and required corrections.
Coordinate comprehensive, quarterly, significant-change, significant-correction, entry, discharge, and Medicare assessments in accordance with the RAI Manual and CMS requirements.
Review MDS coding for consistency with the resident’s current condition, diagnoses, functional status, clinical services, therapy services, restorative programs, and supporting documentation.
Monitor Care Area Assessments, care-plan development, and interdisciplinary participation to ensure identified needs are addressed and documentation is complete.
Track rejected submissions, validation reports, warning messages, late assessments, modifications, and inactivations through resolution.
Provide coverage or direct assistance with MDS completion when operationally necessary and within the employee’s licensure and competency.

2. Clinical Reimbursement and PDPM Oversight

Review Medicare Part A, Medicare Advantage, Medicaid, managed care, and other payer-related clinical documentation and reimbursement requirements.
Validate PDPM components, including diagnoses, nursing classification, functional scoring, non-therapy ancillary services, speech-language pathology factors, and therapy utilization, as applicable.
Monitor admissions, hospital returns, changes in condition, payer changes, interrupted stays, and other events that may affect assessment or reimbursement requirements.
Identify potential missed reimbursement, unsupported coding, documentation inconsistencies, or compliance risks and promptly communicate findings to facility leadership.
Participate in Triple Check and other pre-billing reviews to validate census, covered days, payer source, assessment completion, physician certification, authorization, and supporting documentation.
Collaborate with the Business Office and managed care personnel to monitor authorizations, continued-stay reviews, notices, denials, and appeal deadlines.

3. Clinical Documentation Review

Conduct routine concurrent and retrospective medical record audits to verify that documentation supports skilled coverage, medical necessity, diagnoses, MDS coding, services rendered, and reimbursement.
Review nursing documentation, physician and practitioner notes, hospital records, therapy documentation, medication and treatment records, restorative nursing records, care plans, and other supporting assessments.
Identify documentation gaps, conflicting information, copy-forward concerns, incomplete records, or untimely entries and provide clear corrective guidance.
Promote resident-specific documentation that describes the resident’s condition, risks, skilled needs, interventions, progress, response to treatment, and discharge potential.
Follow up on identified deficiencies to verify timely correction and sustained improvement.

4. Compliance, Auditing, and Quality Improvement

Maintain current knowledge of CMS requirements, the RAI Manual, PDPM, Medicare coverage criteria, Medicaid case-mix requirements, managed care rules, and applicable state regulations.
Conduct scheduled and focused audits based on facility risk, survey findings, denials, quality trends, late assessments, or leadership direction.
Assist with additional documentation requests, medical reviews, payer audits, denials, appeals, and reimbursement-related inquiries.
Develop written findings, corrective action recommendations, education plans, and follow-up monitoring when deficiencies are identified.
Participate in the Quality Assurance and Performance Improvement process and present reimbursement, assessment, and documentation trends as assigned.
Maintain resident confidentiality and comply with HIPAA, privacy, security, infection-control, and facility policies.

5. Key Performance Expectations

MDS assessments are completed, transmitted, and corrected accurately and within required timeframes.
PDPM and case-mix classifications are accurate and supported by resident-specific clinical documentation.
Skilled coverage and medical necessity documentation are complete, timely, and consistent across disciplines.
Triple Check and pre-billing reviews are completed before claim submission, with identified discrepancies resolved or escalated.
Assessment rejections, late submissions, reimbursement denials, and repeat documentation deficiencies are reduced.
Facility staff receive timely education, practical feedback, and follow-up support.
Audit findings and corrective actions are documented, communicated, and monitored through completion.

6. Required Qualifications

Current, active Registered Nurse license in the state of practice is preferred. A Licensed Practical Nurse with substantial MDS and skilled nursing reimbursement experience may be considered based on facility requirements.
Minimum of three years of MDS, clinical reimbursement, utilization review, or skilled nursing experience.
Working knowledge of MDS 3.0, the RAI process, PDPM, Medicare Part A, Medicare Advantage, Medicaid reimbursement, managed care, skilled documentation, and care planning.
Experience completing, reviewing, or auditing MDS assessments and supporting clinical records.
Proficiency with electronic medical record systems, MDS software, Microsoft Office, and basic spreadsheet reporting.
Strong analytical, organizational, communication, education, and problem-solving skills.
Ability to manage multiple deadlines, maintain confidentiality, and exercise sound clinical and compliance judgment.

Quick Apply

Refine Your Search

clinical specialist jobs in orlando, fl

Clinical Reimbursement Specialist RN/LPN

Clinical Documentation Specialist III

Clinical Documentation Specialist II

Clinical Documentation Integrity Specialist

Clinical Quality Specialist - BSN - Surgery Area - Preferred Experience

Clinical Specialist CRM - Orlando

Clinical Nurse Specialist RN Operations Quality Improvement

Clinical Donor Program Specialist

Principal Clinical Specialist

Clinical Quality Specialist II

Home Health Clinical Review Specialist (Part-Time/Weekends)

Clinical Specialist

Clinical Regulatory Specialist RN Waterford Lakes Free-Standing ER

Clinical Quality Specialist II

Clinical Regulatory Specialist RN Flamingo Crossing Free-standing ER

Clinical Oncology Specialist, Head & Neck

Clinical Regulatory Specialist RN Emergency Department

Imaging Clinical Applications Specialist, Orlando - Bracco Diagnostics Inc.

Navigator - Non-Clinical - Neurosurgery - FT - Days - MPG

Clinical Billing Specialist - Medicaid

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