Clinical Reimbursement Consultant
Clinical Reimbursement Consultant
Description
Unique remote opportunity for an experienced MDS Nurse to work in a professional atmosphere alongside experienced MDS consultants in the role of a Clinical Reimbursement Consultant.
The successful candidate will excel in critical thinking, accuracy, and excellent communication skills while thriving in an independent remote environment for an organization that is passionate about propelling our clients’ success. This full-time position reports to the Director of Clinical Consulting.
The Clinical Reimbursement Consultant supports SNF’s by providing a variety of consulting services, such as MDS completion, teaching and training, PDPM coding, case mix review, and auditing services that are related to CMS initiatives, regulatory compliance, MDS coding, billing, and reimbursement accuracy, Five-Star rating improvement, facility leadership and operational development, and clinical program development.
Essential Functions of the Job:
- Provide interim MDS completion services, as assigned focusing on accurate scheduling, completion, and submission of MDS following RAI Guidelines
- Provide SNF auditing services with ability to focus on reimbursement accuracy/optimization, Case Mix Management, Quality Measure arrangement, and MDS accuracy reviews.
- Provide professional consulting services, as assigned to Engage Consulting customers focusing on MDS/Skilled Nursing Facility
- (SNF) reimbursement and operations.
- Maintain clinical and regulatory knowledge in accordance with current geriatric care standards of practice, including but not limited
- to Federal Survey Requirements, MDS 3.0 RAI Manual, federal and state health regulations, CMS Requirements of Participation,
- and payor guidelines.
- Consistently demonstrate sound judgement and provides ethical guidance to customers for SNF practices.
- Provide direct assistance to the Senior Practice Manager and Director of Clinical Consulting as requested.
- Must be familiar with Electronic Medical Record (EMR) programs including Point Click Care, Matrix Care, and therapy software systems.
- Ability to work remotely and independently with occasional travel requirements.
- Consistently portray the mission, vision, core values, cornerstones and professional image of Engage Consulting, exercise good judgement in the performance of the job.
- Special projects and other duties as assigned.
Requirements
Required Qualifications:
- Registered Nurse (RN) with active Nursing licensure.
- Prior regional MDS and/or multi-state experience required
- Minimum five years of experience performing MDS completion in a SNF.
- AAPACN Resident Assessment Coordinator Certification (RAC-CT) preferred.
- Intermediate knowledge of SNF Reimbursement and Billing Regulations, including but not limited to RAI guidelines, PDPM
- Reimbursement, Case Mix Management, and specific state nursing documentation guidelines.
- Intermediate knowledge of Microsoft Office (Word, Excel, PowerPoint, and Outlook).
Core Competencies
Healthcare Billing Expertise, Relationship Management, Project Management, Excellent Interpersonal Skills, High Emotional Intelligence, Outstanding Oral and Written Communications, Functional Business Knowledge, Technological Skills, Problem-Solving and Analytical Skills, Critical Evaluation, Cultural Awareness, Ethical Practice, Ability to Exercise Independent Judgment and Discretion, Maintain Confidentiality.
