What are the responsibilities and job description for the Regional Clinical Reimbursement Specialist position at Ascentria Care Alliance?
Job Details
Description
The Regional MDS Coordinator ensures maximum and appropriate reimbursement for Medicaid, Medicare, Medicare Advantage and Commercial Insurance plans to assigned facilities. This role provides support and oversight to facility MDS and Case-Mix Coordinators, Case Managers and facility teams to ensure MDS coding accuracy through clinical documentation systems while driving positive clinical and financial outcomes.
About The Company
Ascentria Care Alliance employees and volunteers take pride in the impact they have on the people they serve. It’s more than just a job; it’s an opportunity our employees have to care for and share in the lives of people who greatly need and appreciate their presence. Ascentria Care Alliance focuses on every child, elder, disabled person, refugee, endangered teen or teenage mom in order to build stronger communities one person at a time. This is an excellent opportunity to enhance the operations of a $120m non-profit social services organization with programs throughout New England.
Essential Job Functions: Responsibilities and Standards
Qualifications
5 years- MDS experience Preferred
Regional, multi facility experience
Description
The Regional MDS Coordinator ensures maximum and appropriate reimbursement for Medicaid, Medicare, Medicare Advantage and Commercial Insurance plans to assigned facilities. This role provides support and oversight to facility MDS and Case-Mix Coordinators, Case Managers and facility teams to ensure MDS coding accuracy through clinical documentation systems while driving positive clinical and financial outcomes.
About The Company
Ascentria Care Alliance employees and volunteers take pride in the impact they have on the people they serve. It’s more than just a job; it’s an opportunity our employees have to care for and share in the lives of people who greatly need and appreciate their presence. Ascentria Care Alliance focuses on every child, elder, disabled person, refugee, endangered teen or teenage mom in order to build stronger communities one person at a time. This is an excellent opportunity to enhance the operations of a $120m non-profit social services organization with programs throughout New England.
Essential Job Functions: Responsibilities and Standards
- They are responsible for maximizing reimbursement for healthcare services by understanding payer policies, identifying potential denials, and ensuring accurate documentation.
- Oversee clinical reimbursement accuracy of MDS coding, care planning and clinical documentation according to OBRA RAI guidelines.
- Directly responsible for compliance of clinical reimbursement, including accurate and timely documentation of patient interactions, care plans, and clinical activities in accordance with regulatory and company standards.
- Responsible for supporting facility based follow up after review/audit findings from Quality Assurance, Compliance, and consultation reviews. Collaborates with centers to ensure follow through of internal and external audits that impact these areas.
- Monitor MDS Completion and Transmission of MDS assessments and conduct clinical reviews to support MDS accuracy and pertinent PDPM data accuracy. Provides interim support as needed.
- Analyze reimbursement data to identify trends, opportunities for improvement, and areas of concern.
- Contributes to the implementation and modification of ACO Models of Care, Length of stay delivery and successful discharge planning.
- Build and maintain relationships with insurance companies and other payers to facilitate smooth reimbursement processes.
- ICD-10 Coding for accuracy and reimbursement
- Provide education to centers to support process and enhance collaboration among team members
- Assures Medicaid documentation is complete in accordance to state and federal regulations and works closely with facility leadership, interdisciplinary team members and direct care staff as needed.
- Assist centers with Case Mix audits and educate facility staff to ensure readiness and appropriate plans are in place. Communicates with regional team and supports centers during audits by the Office of Long Term Care or its contractors’.
- Leads meetings at designated centers to discuss documentation audit findings, assisting team to identify/capture significant changes early and/or need for additional resources
- Ensure implementation of all documentation systems to licensed and non-licensed staff and works collaboratively with facility teams to achieve best possible outcomes
- Responsible for follow through of reports findings as well as assists with plans of improvement
- Registered Nurse, RN
- Current professional licensure in the state of hire.
- Five years MDS experience and multi center level management preferred.
- Possess strong oral and written communication skills. Organizational and analytical skills required.
- Ability to function effectively in multi-faceted systems and to interact effectively with all levels of staff and customers.
- Medical
- Dental
- Vision
- FSA and dependent care account
- 3 Weeks PTO and 9 Holidays!
- Tuition Assistance
- And many more!
Qualifications
5 years- MDS experience Preferred
Regional, multi facility experience
