What are the responsibilities and job description for the Clinical Reimbursement Specialist-Remote position at Healthpro Heritage, LLC?
The Clinical Reimbursement Specialist position provides medical record review, consultant support and written reporting necessary to optimize clinical reimbursement, clinical practice, and quality assurance and compliance through consultant directed and proactive chart audits within our LTC division of consulting. They will work collaboratively with the clinical services team in delivering the highest quality service to our clients. This position requires specific and deep knowledge of the patient driven payment model, Case Mix Index (CMI), Quality Measures, Quality Reporting, value based care and overall LTC payment. This position also requires an intermediate understanding of regulations for submission of various documentation, other regulations, etc. that may impact overall reimbursement and payment. The position accomplishes all of the above through a respectful, constructive and energetic style, guided by the objectives of the company.
As one of the company’s expert, detailed medical reviewers and clinical reimbursement support staff, this position functions as a member of the Company’s Clinical Strategies & Consulting division, in alignment with our mission and values. The candidate must be a licensed practitioner with a reimbursement understanding and be willing to travel throughout the US on an as needed based at times. MUST have MDS and LTC reimbursement experience.
- Completes remote PDPM, CMI, QRP, VBP & QM audits as indicated
- Participates in video conferencing and educational webinars as needed
- Collaborates with Consultants on projects as assigned
- Maintains a caseload for consulting clients, working with those consultants and clients to complete medical reviews, reporting and discuss in a timely manner
- Participates in ongoing clinical strategies consulting updates and trainings as indicated to stay up to date on reimbursement or charting changes, etc.
- Stays up to date on industry trends, regulations, reimbursement changes, and other changes as needed to be effective in the current SNF market
- Provides in-services and training to regional and facility clinical staff as needed
- Conducts and/or participates conference calls with partners/ meetings for communication & training as needed
- Collaborates with QAC, Clinical Strategies and Denials teams as needed for growth and improvement
- Degree in Nursing Preferred. Bachelors, Master’s Degree and or Doctorate Degree in Physical Therapy, Occupational Therapy or Speech and Language Pathology or an Associate’s Degree as a Physical Therapist Assistant or an Occupational Therapist Assistant
- Current license in the state(s) assigned
- Minimum of 5 years of SNF, Post acute setting and rehabilitation experience
- Minimum of 3 years in clinical reimbursement, medical coding, or healthcare billing.
- Minimum of 1 year in a regional, multi-site or consulting role.
- Strong understanding of PDPM, RAI, and ICD-10.
- Highly skilled in virtual and technological communications and interactions.
- MDS certification (RAC-CT) or other advanced certification preferred.
- Knowledge of state, federal and therapy practice act legislation/law and accreditation standards.
- Interdisciplinary management and understanding essential.
- Experience presenting at conferences and speaking engagements are a plus.
