Clinical Reimbursement Coordinator

Job Details: Job Location: Montgomery, AL 36104, Position Type: Full Time, Education Level: 2 Year Degree, Job Shift: First, Job Summary Job Summary The Clinical Reimbursement Coordinator in our Skilled Nursing Facility (SNF) oversees and coordinates the Minimum Data Set (MDS) process and ensures accurate and timely completion of the MDS assessments. Additionally, the Clinical Reimbursement Coordinator is crucial in managing the Patient-Driven Payment Model (PDPM) to optimize reimbursement and support the facility's financial goals. Key Responsibilities MDS Coordination: Oversee the MDS process and ensure compliance with state and federal regulations. Coordinate and manage the completion of the MDS assessments, including the initial, significant change, quarterly, and annual assessments, in collaboration with the interdisciplinary team. PDPM Management: Understand and stay updated on the PDPM guidelines and requirements. Collaborate with the interdisciplinary team to ensure accurate coding and documentation to support appropriate reimbursement under the PDPM system. Assessment and Documentation: Review residents' medical records, observe their conditions, and interview residents and their families to gather necessary information for MDS assessments. Accurately complete MDS assessments and other required documentation within designated timeframes. Care Plan Development: Collaborate with the interdisciplinary team to develop individualized care plans based on MDS assessments and residents' needs. Ensure care plans are regularly reviewed, updated, and implemented to support quality care and maximize resident outcomes. Quality Assurance: Conduct audits and quality checks on MDS assessments and documentation to ensure accuracy, completeness, and compliance with regulations. Identify areas for improvement and provide education and training to staff as needed. Interdisciplinary Collaboration: Work closely with the nursing staff, therapists, social workers, and other healthcare professionals to gather information, share updates, and ensure accurate and comprehensive assessment and documentation of residents' conditions and care needs. Reimbursement Optimization: Analyze MDS assessments, coding, and documentation to identify opportunities for optimizing reimbursement under the PDPM system. Collaborate with the financial team to monitor reimbursement trends, address coding and documentation issues, and maximize financial outcomes. Staff Education: Provide education and training to staff on MDS assessment requirements, coding guidelines, and PDPM documentation best practices. Stay updated on changes in regulations and guidelines and communicate them to the interdisciplinary team. Compliance: Ensure compliance with federal and state MDS assessments, documentation, and reimbursement regulations. Stay informed about changes in regulations and guidelines and implement necessary updates in MDS processes and documentation practices. Data Management and Reporting: Collect and analyze data related to MDS assessments, reimbursement, and resident outcomes. Generate reports and communicate findings to the management team, highlighting areas for improvement and strategies for enhancing resident care and financial performance. Qualifications: Preferred Qualifications and Skills Registered Nurse (RN) or Licensed Practical Nurse (LPN) licensure is preferred. In-depth knowledge of the MDS assessment process, coding guidelines, and federal regulations related to MDS and reimbursement (e.g., PDPM). Prior experience in MDS coordination and familiarity with MDS software systems. Strong understanding of the PDPM payment model and its impact on reimbursement in the SNF setting. Excellent analytical skills and attention to detail in assessing, coding, and documenting resident information. Proficient in using computer software and applications for data management and reporting. Ability to collaborate effectively with the interdisciplinary team and communicate complex information to staff members. Strong organizational and time management skills to meet MDS assessment and reporting deadlines. Knowledge of quality assurance and performance improvement principles. Familiarity with electronic health record (EHR) systems and healthcare technology. Ability to adapt to changes in regulations and guidelines related to MDS and reimbursement. Working Conditions Works in office area(s) as well as throughout the nursing service area (i.e., drug rooms, nurses’ stations, resident rooms, etc.). Moves intermittently during working hours. Is subject to frequent interruptions. Is involved with residents, personnel, visitors, government agencies/personnel, etc., under all conditions and circumstances. Is subject to hostile and emotionally upset residents, family members, personnel, and visitors. Communicate with the medical staff, nursing personnel, and other department directors. Works beyond normal working hours and on weekends and holidays when necessary. Is subject to call back during emergency conditions (e.g., severe weather, evacuation, post-disaster, etc.). Is involved in community/civic health matters/projects as appropriate. Attends and participates in continuing educational programs. Is subject to injury from falls, burns from equipment, odors, etc., throughout the workday, as well as reactions from dust, disinfectants, tobacco smoke, and other air contaminants. Is subject to exposure to infectious waste, diseases, conditions, etc., including TB and the AIDS, COVID-19, and Hepatitis B viruses. May be subject to the handling of and exposure to hazardous chemicals. Maintains a liaison with the residents, their families, support departments, etc., to adequately plan for the residents’ needs. Education Must possess and maintain any and all necessary active and unencumbered certifications, degrees, or licenses in the necessary state, to the extent the position requires such certifications, degrees, or licenses. Specific Requirements Must demonstrate the knowledge and skills necessary to provide care appropriate to the age‑related needs of the residents served. Must be a supportive team member, contribute to and be an example of teamwork and team concept. Must possess the ability to make independent decisions when circumstances warrant such action. Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the general public. Must be able to relate information concerning a resident’s condition. Must not pose a direct threat to the health or safety of other individuals in the workplace. Physical and Sensory Requirements (with or without reasonable accommodation) Must be able to move intermittently throughout the workday. Must be able to read, speak, and understandably write the English language. Must be able to cope with the mental and emotional stress of the position. Must function independently, and have flexibility, personal integrity, and the ability to work effectively with residents, personnel, and support agencies. Must meet the general health requirements set forth by the policies of this facility, which include a medical and physical examination if the position requires. Must be able to relate to and work with the ill, disabled, elderly, emotionally upset, and, at times, hostile people within the facility. Must be able to push, pull, move, and/or lift a minimum of 50 pounds to a minimum height of 5 feet and be able to push, pull, move, and/or carry such weight a minimum distance of 50 feet. May be necessary to assist in the evacuation of residents during emergencies. (With or Without the Aid of Mechanical Devices) Must be able to push, pull, move, and/or lift a minimum of 50 pounds to a minimum height of 5 feet and be able to push, pull, move, and/or carry such weight a minimum distance of 50 feet. All Other Duties as Assigned. I understand this job description and its requirements; I understand that this is not an exclusive list of the job functions and that I am expected to complete all duties as assigned; I understand the job functions may be altered by management without notice and that I am an at-will employee. Accommodations The facility is an equal opportunity employer and recognizes that an individual with a disability may require accommodation to enable the individual to successfully perform a job function. I understand that I should discuss with my supervisor any needed accommodation. I agree to cooperate with the facility in identifying and discussing any available reasonable accommodation that may enable me to perform the essential function(s) of my position. #J-18808-Ljbffr Paycom - ATS