Elderly Waiver Reimbursement Specialist
About The Position
The Elderly Waiver (EW) Reimbursement Specialist is responsible for ensuring accurate, timely, and compliant reimbursement for residents receiving services through Minnesota waivers, primarily EW and CADI. Key Responsibilities Manages reimbursement for services provided to residents utilizing EW/CADI in assisted living settings, in collaboration with Director of Elderly Waiver, MA Specialist, Billing Specialist, Clinical, Operations and Admissions. Confirms eligibility prior to admission – MN-ITS verifications Completes 6790/Customized Living tools utilizing clinical documentation as well as face to face interactions. Ensures documentation supports authorized services. Direct communication with clinical in each community to be updated on changes to services and leave of absences Monitor support plans, service authorizations, rate changes, and renewals Audit EMR to ensure changes of conditions are being accurately reported and updated 6790 submitted as appropriate Educate clinical and administrative staff on documentation best practices impacting reimbursement Identify reimbursement risks and proactively recommend corrective actions Stay current with Minnesota DHS waiver policies, rate frameworks, and regulatory changes Work onsite with residents and staff through all facilities in metro area.
Requirements
- 2+ years of experience with Elderly Waiver reimbursement or care coordination
- Experience working in assisted living, home care, or long-term care settings
- Excellent attention to detail and strong organizational skills
- Ability to work collaboratively with clinical, financial, and county partners
- Bachelor or Associate degree in Nursing, Social Work, Healthcare Administration, or a related field preferred.
- Equivalent experience may be considered in lieu of formal education.
Nice To Haves
- Established relationships with county case managers and state billing entities.
- Experience with Eldermark or similar EHR and Medicaid billing systems.
- Experience with CADI or BI waivers
- Prior reimbursement, MDS, or utilization review experience
Responsibilities
- Manages reimbursement for services provided to residents utilizing EW/CADI in assisted living settings, in collaboration with Director of Elderly Waiver, MA Specialist, Billing Specialist, Clinical, Operations and Admissions.
- Confirms eligibility prior to admission – MN-ITS verifications
- Completes 6790/Customized Living tools utilizing clinical documentation as well as face to face interactions.
- Ensures documentation supports authorized services.
- Direct communication with clinical in each community to be updated on changes to services and leave of absences
- Monitor support plans, service authorizations, rate changes, and renewals
- Audit EMR to ensure changes of conditions are being accurately reported and updated 6790 submitted as appropriate
- Educate clinical and administrative staff on documentation best practices impacting reimbursement
- Identify reimbursement risks and proactively recommend corrective actions
- Stay current with Minnesota DHS waiver policies, rate frameworks, and regulatory changes
- Work onsite with residents and staff through all facilities in metro area.
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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
