Clinical Reimbursement Mgr - RN

Vi Living•Hilton Head Island, SC

5d•Onsite

About The Position

This is a salaried position with a compensation range of $82,487.45 - $107,228.73 or MORE based on experience. The schedule is Monday - Friday with an on-call weekend rotation every 4 weeks. Relocation can be discussed. Vi is recognized as a Great Place to Work and one of Glassdoor's 100 Best Companies to work for. Learn from the best and accelerate your career with Vi. The role is located at TidePointe, a Vi Community, at 700 TidePointe Way, Hilton Head Island, SC 29928.

Requirements

Graduation from a School for Registered Nurses is required.
Minimum 3 years of previous experience in an MDS/Clinical Reimbursement Nurse role is 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.
Maintains a courteous and professional manner through interactions with others.
Uses a resident and customer-focused approach to problem solving and goal setting.
Uses discretion in handling confidential information, incorporating all Federal, State and local privacy and confidentiality requirements.
Must possess knowledge of regulatory compliance and Continuing Care Retirement Community operations.
Excellent knowledge of Case-Mix, and the Federal Medicare PPS process as required.
Thorough understanding of the Quality Indicator Process, and OBRA regulations.
Excellent oral and written communication skills and ability to interface and maintain effective relationships with all departments and employees in a team-oriented environment.
Computer proficiency using Microsoft Office.
Must be sensitive to the needs of older adults and enjoy working with a senior population.

Responsibilities

Collaborates with the DON, Clinical Reimbursement Specialist (where applicable) and various disciplines to complete the Minimum Data Set (MDS), Resident Assessment Instrument (RAI), and all associated processes.
Ensures completion of the assessment within the timeframe as mandated by federal regulations and company policies, with guidance and oversight from the DON.
Manages the overall process and tracking of all Medicare/Managed Care/Medicaid case mix documents to ensure appropriate and optimal reimbursement for services provided within the Care Center.
Assists with the coordination of the resident care planning processes.
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 and collaborates with the Clinical Reimbursement Specialist (where applicable) or DON to address concerns.
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 in addressing concerns.
Confirms that residents and their families are actively involved in the information sharing and decision-making process.
Completes resident assessment protocol documents within scope of practice.
Assists with the completion of the resident care plan and the care plan conferences per requirements as requested by the DON.
Provides resident and family education as needed.
Identifies and reports deviations from safe practice to the DON.
Adheres to policies and guidelines of regulatory agencies (i.e. OSHA, CMS).
Manages emergency situations based on the Company’s safety and disaster policies.
Communicates and collaborates with other members of the healthcare team to resolve resident care problems and to enhance care delivery.
Participates in quality assessment/performance improvement activities and audits.
Maintains minimum data set competencies and attends annual educational programs.
Attends/participates in care center meetings, in-services and committee meetings.
May perform CPR, use Automated External Defibrillator (AED), and render first aid in emergency situations.