Portland, Maine
Regional Reimbursement Specialist - Maine Job Opening in Portland, Maine - National HealthCare Associates, a provider of high quality healthcare services in the Northeastern US, is seeking a Registered Nurse for a Regional Reimbursement Specialist opportunity covering our 8 skilled nursing facilities in the state of Maine.
MAJOR PURPOSE: To promote the capture of appropriate clinical reimbursement for services provided while ensuring highest level of revenue integrity with support of corporate established reimbursement initiatives.
TITLE OF SUPERVISOR : Director of Clinical Reimbursement
TITLE OF IMMEDIATE SUBORDINATES: None
QUALIFICATIONS:
Registered nurse with 3+ years reimbursement or similar experience in the LTC industry.
Computer literacy (Word, Excel, Power Point, Outlook). Experience with current EMR software a plus.
Evidence of effective written, verbal and technological communication.
Demonstrates excellent organization, communication and presentation skills.
Deadline driven, detail oriented individual with strong analytical capabilities.
Working knowledge of state and federal regulations governing the MDS and billing processes within a nursing facility.
Ability to communicate with and elicit support from other regionals and IDT members at the facility level.
Ability to apply knowledge in state specific Medicaid and Medicare RUG methodologies.
Ability to successfully train new MDS coordinators and IDT members with varying levels of experience as appropriate.
Ability to conduct themselves with a fair, honest, consistent, and professional temperament.
Ability to travel >50%, with possible overnight and out of state travel assignments.
Exhibits independent and self-directed work ethic with the ability to manage multiple facilities data.
WORKING CONDITIONS: Works in appropriately lighted and ventilated environment.
PHSYICAL REQUIREMENTS:
Ability to drive up to 240 miles per day.
Can cope with the mental, emotional and physical stress of this deadline driven position.
Can see and hear, or use prosthetics that will enable these senses to function adequately to ensure that the requirements of this position can be fully met.
Must function independently, have flexibility, personal integrity, and the ability to work effectively with residents, personnel, support agencies, and outside agencies.
Must be in good health and display emotional stability.
Must have finger, hand, leg, and arm dexterity (one leg/foot prosthesis acceptable).
PRIMARY FUNCTIONS:
Optimize reimbursement and identify opportunity through tracking, trending, and analyzing relevant data with supervisor guidance.
Strategic planning as relates to case-mix systems.
Perform auditing activities as outlined by the Director of Clinical Reimbursement.
Perform consistent, focused data mining throughout assigned region.
Provide facility visits as required with timely (48*) report of findings.
Respond promptly to facility and regional team inquiries related to MDS and reimbursement.
Provide management level presentation materials during quarterly meetings as outlined.
Participate in the hiring of MDS coordinators.
Assist with orientation and education for MDS coordinators and other IDT members as relates to MDS and/or reimbursement processes.
Provide ongoing education and communication with the facility Administrators, MDS staff, and clinical staff as relates to current state and federal regulation governing billing and reimbursement in respective region.
Other related duties as assigned.
Job Type: Full-time
Required experience:
Multi-Facility Reimbursement: 5 years
Required license or certification:
Registered Nurse
|
