What are the responsibilities and job description for the Regional Clinical Reimbursement Specialist position at Volare Health, LLC?
Summary/Objective: The Regional Clinical Reimbursement under direction of the Director, provides support, education, and training to the MDS Coordinators in the facilities on the Resident Assessment Instrument (RAI) process in accordance with the laws, regulation, and company standards. Reviews and coordinates PDPM and Case Mix data to ensure appropriate reimbursement.
Location: Louisiana
Schedule: Full-time
Compensation: $115,000/K - $125,000/K (Salaried)
Essential Functions
Location: Louisiana
Schedule: Full-time
Compensation: $115,000/K - $125,000/K (Salaried)
Essential Functions
- Provides leadership, oversight and acts as a resource for regional and facility staff specific to the RAI process, the Medicare program, and Medicaid Case Mix.
- Conducts regular monitoring of facility Medicare management and Case-Mix
- Works in coordination with the Regional Nurse Consultant to provide regional and facility interdisciplinary (IDT) teams with education and support for the development of systems to address and manage Quality Measures (QM) and the CMS Five Star Rating.
- Supports accurate claims and billing.
- Leads and participates in program improvement and development efforts related to the RAI, Medicare and Medicaid programs.
- Conducts follow-up evaluations to validate those systems are functioning well after initial roll-out.
- Participates in the Quality Assurance Process Improvement Program:
- Identifies and evaluates trends
- Assists with Root Cause Analysis
- Assists in identifying appropriate solutions
- Supports facility follow-up through appropriate measurement design
- Participates during “mock survey” process related to RAI with Regional Team as requested, and preparation for state and federal surveys as assigned.
- Current license as a Registered Nurse issued by the State Board of Nursing
- Bachelor’s or associate degree in nursing from accredited college
- Minimum 3 years’ experience with the RAI process
- Prior multi-facility experience a plus
- Strong Knowledge of PDPM and State Case Mix Time weighted Reimbursement payment system.
- Knowledgeable of the nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to long-term care.
- Effective verbal and written English communication skills.
- Ability to communicate at all levels of the organization and work well within a team environment in support of company objectives.
- Customer service oriented with the ability to work well under pressure.
- Strong attention to detail and accuracy, excellent organizational skills with ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity.
- Ability to work with minimal supervision, take initiative and make independent decisions.
- Approachable, flexible, and adaptable to change.
- Function independently, and have flexibility, personal integrity, and the ability to work effectively with employees and vendors.
- Demonstrate basic to intermediate skills in Microsoft Word, Excel, Power Point, and Internet navigation, preferred.
- High level of professionalism with the ability to maintain confidentiality.
- Ability to travel throughout the state of Louisiana.
- Opportunities for career advancement within a dynamic healthcare environment.
- Comprehensive health, dental, and vision insurance coverage for you and your family.
- Company-paid life insurance policy.
- Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
- Generous paid time off (PTO) policy.
- Tuition reimbursement program to support continued education.
Salary : $115,000 - $125,000
