Regional Reimbursement Analyst - Oregon State Region

Avamere • Wilsonville, OR

107d

About The Position

The Reimbursement Analyst is a key support staff member responsible for understanding governmental regulatory reporting needs. Serves as a resource for facilities on the RAI process, reimbursement (Medicare, Medicaid, OBRA and other payor programs) and Quality measures. Participates in the development of the QAPI and Action Plans for the RAI process.

Requirements

• Must possess a current, unencumbered, active license to practice as a Registered Nurse in the state of Oregon or Washington.
• Must have a minimum of 2 years of experience with RAI process; 3 years' experience in Long Term Care and Skilled Nursing facility setting.
• Proficient in the RAI process, PDPM, QRP, VBP and 5-star rating.
• Able to travel and if needed stay local to an assigned facility while functioning as the Interim MDS Coordinator.
• Prior demonstrable experience developing, implementing and monitoring systems to ensure Organization compliance with federal/state requirements, RAI process.
• Excellent communication, presentation, and facilitation skills.
• Experience with Electronic Medical Records and computer documentation systems.
• Ability to learn, respect and respond to the different needs and challenges of the different business units.

Nice To Haves

• CMAC certification.
• Five (5) years PCC or other equivalent Emar experience.

Responsibilities

• Assists in the development and implementation of QAPI plans for clinical reimbursement and attends Regional QAPI meetings.
• Performs routine risk assessments for assigned facilities to determine risk and actionable plans.
• Coordinate with high-risk facilities and develop performance improvement plan.
• Provides facility leadership Quality measure and QRP threshold reports.
• Implement training for CMS/MDS changes and provide education to assigned facilities.
• Conducts routine audits of MDS coding to ensure accuracy and identify opportunities for process improvement.
• Assists in the orientation and training of new MDS coordinators on the RAI process, Federal and State regulations.
• Provides support to the facilities by assisting the Clinical Reimbursement Specialist in answering questions.
• Maintains current knowledge of reimbursement regulations.
• Maintains data in an organized, easily retrievable manner.
• Communicates regularly with Administrator to discuss identified clinical reimbursement issues.
• Utilizes Clinical Reimbursement Department as resource and clarification over processes.
• Assist with preparation of materials utilized by the client organization as needed.
• Attend company meetings, event and planning sessions as needed.
• Assist with other activities as directed by the CNO.

What This Job Offers

• Job Type: Full-time
• Industry: Nursing and Residential Care Facilities