Avera
Healthcare
RegisteredNurse(RN)ClinicalReimbursementSpecialist
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Registered Nurse (RN) Clinical Reimbursement Specialist at Avera. Skills: Clinical Reimbursement, MDS coding, Regulatory knowledge, Analytical skills. Ensuring accurate clinical documentation, assessment and Minimum Data Set (MDS) coding to support appropriate reimbursement.. Overseeing compliance, accuracy and optimization of clinical reimbursement strategies for the LTC Division.”
Industry & Context.
Utilizes clinical judgement and nursing process; Analyzes reimbursement trends, identify deviations, implement corrective action plans
Must be willing to travel.
What They're Looking For.
Must Have
Registered Nurse (RN) - Board of Nursing, Resident Assessment Coordinator - Certified (RAC-CT) - American Association of Post-Acute Care Nursing (AAPACN), leadership and communication skills with the ability to train and mentor teams
Nice to Have
Bachelor's, Extensive knowledge of Medicare, Medicaid, PDPM, Managed Care, QM, and CMI reimbursement systems, expertise in MDS processes, including completion, regulatory compliance, Regional MDS experience, Proficiency in analyzing reimbursement trends, auditing, and implementing performance improvements
What You'll Do.
Ensuring accurate clinical documentation
assessment and Minimum Data Set (MDS) coding to support appropriate reimbursement.
Overseeing compliance
accuracy and optimization of clinical reimbursement strategies for the LTC Division.
Providing clinical reimbursement compliance and overarching MDS support to teams across Avera.
Maintaining knowledge of federal regulations
as well as guidelines pertaining to the RAI process.
Developing division strategies for maximizing reimbursement for PDPM
Managed Care and other payer models.
Utilizing clinical judgement and nursing process to be a resource for Nurse Assessment Coordinators
Interdisciplinary team members and LTC Leaders.
Partnering with payor contracting on Managed Care/ACO contract utilization and ensuring facilities adhere to payer guidelines
timely filing requirements
and pre-authorization processes.
Auditing and implementing action plans to improve staff education/competency as needed to ensure accurate and timely completion of supporting documentation and MDS assessment.
Monitoring facility schedules for timely and complete MDS data submission as per Federal
and other payor requirements.
Analyzing reimbursement trends
implement corrective action plans through utilization of system data and analytic resources.
Acting as a liaison between facilities
and system resources to ensure accurate reimbursement levels.
Providing ongoing operational support and guidance to facilities regarding denial management
and reimbursement strategies.
Leading the division efforts to implement best practices for accurate capture of the data elements of the Minimum Data Set (MDS)
which is the key driver of the care plan
quality measures and reimbursement programs.
How You'll Work.
Team & Collaboration
Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients.; Utilizes clinical judgement and nursing process to be a resource for Nurse Assessment Coordinators, Interdisciplinary team members and LTC Leaders.; Acts as a liaison between facilities, finance, MDS, nursing, and system resources to ensure accurate reimbursement levels.; Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
Communication Scope
ability to communicate effectively with others; hear, understand and distinguish speech and other sounds; communication skills
Process & Methodology
Develop division strategies for maximizing reimbursement for PDPM, Managed Care and other payer models., Audits and implements action plans to improve staff education/competency as needed to ensure accurate and timely completion of supporting documentation and MDS assessment., Implement best practices for accurate capture of the data elements of the Minimum Data Set (MDS)
Full Job Description
**Location:** Avera at Home Sioux Falls **Worker Type:** Regular **Work Shift:** Day Shift (United States of America) **Pay Range:** _The pay range for this position is listed below. Actual pay rate dependent upon experience._ $78,000.00 - $116,480.00 **Position Highlights** Hybrid position with some travel involved **You Belong at Avera** **Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.** **A Brief Overview** Responsible for ensuring accurate clinical documentation, assessment and Minimum Data Set ("MDS") coding to support appropriate reimbursement. This role blends strong clinical expertise with regulatory knowledge and analytical skills. This role will oversee compliance, accuracy and optimization of clinical reimbursement strategies for the LTC Division as well as clinical reimbursement compliance and overarching MDS support to teams across Avera. **What you will do ** * Maintains knowledge of federal regulations, practice standards, and procedures, as well as guidelines pertaining to the RAI process. Develop division strategies for maximizing reimbursement for PDPM, Managed Care and other payer models. * Utilizes clinical judgement and nursing process to be a resource for Nurse Assessment Coordinators, Interdisciplinary team members and LTC Leaders. Develops strategies for maximizing reimbursement under PDPM, Managed Care and other payer models. * Partners with payor contracting on Managed Care/ACO contract utilization and ensures facilities adhere to payer guidelines, timely filing requirements, and pre-authorization processes. * Audits and implements action plans to improve staff education/competency as needed to ensure accurate and timely completion of supporting documentation and MDS assessment. * Monitors facility schedules for timely and complete MDS data submission as per Federal, State, and other payor requirements. * Analyzes reimbursement trends, identify
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