Clinical Reimbursement Specialist/MDS Coordinator – RN
| Company | Illuminus |
|---|---|
| Location | Milwaukee, WI, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | |
| Experience Level | Mid Level, Senior |
Requirements
- Current licensure to practice in Wisconsin as a Registered Nurse.
- Ability to navigate and effectively utilize an Electronic Medical Record program
- Current CPR certification
- Commitment to quality outcomes and services for all individuals.
- Ability to relate well to all individuals.
- Ability to maintain and protect the confidentiality of information.
- Ability to exercise independent judgment and make sound decisions.
- Ability to adapt to change.
Responsibilities
- Responsible for overseeing a health center’s RAI/Minimum Data Set and insurance authorization/coverage processes.
- Responsible for on-call services, as assigned.
- Will ensure center adheres to Medicare coverage requirements; such as certification, assessment, and advance beneficiary notice.
- Will oversee the Medicare meeting and provide direction to support process improvement.
- Will oversee and assure accuracy/quality of the MDS/RAI process, including scheduling, completion and content.
- Will be responsible to review 24 hr. report, physician orders, stand up meeting minutes daily, and monitor for any resident MDS/insurance coverage issues.
- Will manage all requirements to authorize coverage & continued stay from HMO, Insurance, and LTC Policies.
- Will maintain a strong working relationship therapy to determine assessment reference dates, insurance coverage criteria, and patient rehabilitative plan of care.
- Performs other duties, as assigned.
Preferred Qualifications
- AANAC Resident Assessment Coordinator Certification Preferred.
- 4-5 years of experience in Minimum Data Set preferred.