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Hillcrest Commons Clinical Reimbursement Coordinator in Pittsfield, Massachusetts

CLINICAL REIMBURSEMENT COORDINATOR- LPN or RN Essential Job Functions: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. - Perform independent and/or suggested affiliate level, clinical and financial audits as warranted. - Identify and assist with educational opportunities through audit, tracking, trending, and analyzing relevant patient data with supervisor guidance and support. - Strategic planning related to ARDs; optimizing the appropriate revenue systems. - Ensure IDT compliance with state/federal requirements and timeframes related to MDS, billing and care planning. - Interpretation of revenue related data as requested. - Identify revenue related risks associated with missing, irrelevant, erroneous clinical documentation. Assist with action plans related to such risk as warranted. - Assist with orientation and education for CRCs and other IDT members as relates to MDS and/or reimbursement processes. - Provide ongoing education and communication with IDT as relates to current state and federal regulation systems driven by the MDS. - Review clinical charts and assist with determination of ongoing skilled need, and appropriate Length of Stay. - Under the coordination of a Registered Nurse, complete sections of the MDS. - Review, revise and communicate the need for new care plans as per facility protocol. - Attend CP meetings per facility protocol. - Conduct/attend as necessary the daily, weekly, monthly meetings related to Revenue. (Daily REV, Wkly MRA/CMI, Monthly Triple check) - Ensure/assist with the timeliness of managed care updates. - Assist with maintenance, risk and education related to 5 STAR Quality Measures/Value Based Purchasing, and Quality Reporting programs. - Provide information as requested for Additional Documentation Request (ADR) and appeals as appropriate. - Other related duties as assigned. Annual Salary: LPN - \$70,000-\$80,000 RN - \$85,000-\$95,000 Qualifications Experience Preferred 3 years: Reimbursement or similar experience in the LTC industry Licenses & Certifications Preferred REGISTERED NURSE License Practical Nurse