Clinical Reimbursement Coordinator/RN

Title: Clinical Reimbursement Coordinator

Department: MDS

Reports to: Facility Administrator

Responsibilities:

Ensures confidentiality of patient/resident information at all times in accordance with applicable regulations and center policy.
Acts in place of the Clinical Reimbursement Coordinator in her/his absence.
Complies with all applicable facility policies and procedures, Federal and State regulations regarding completion, accuracy and timely electronic submission of the MDS.
Accurately collects and records MDS data per facility policy and procedure. This includes direct observation of the resident and review of all available hospital and center records to ensure that appropriate supporting documentation exists.
Enters data as indicated.
Committee Functions

Works with the interdisciplinary team to coordinate a comprehensive assessment for each resident, to ensure that all assessment triggers are addressed, and that all skilled care needs are identified and met with services.
Works with the team to identify strategies for reconciling differences between pre-morbid status and expected rehab out- come and between likely rehab outcome and planned discharge environment.
Attends Utilization Review committee meetings at least monthly with CRC to remain current with process. Represents Clinical Reimbursement at the meeting in the absence of the CRC Attends/participates in other committee meetings as directed by the CRS.
Reimbursement Functions

Performs pre-admission review, coordinates with Rehabilitation to identify initial RUGs target
Sets reference dates to capture the most complete picture of resident care and service needs.
REQUIREMENTS
We require previous experience as a Reimbursement Nurse Specialist in the long term care industry.

Must possess a current, unencumbered license to practice as a Registered Nurse in the state of practice.

Must be able to read, write, speak and understand the English language.
Must possess the ability to make independent decisions when circumstances warrant such action.
Must possess the ability to deal tactfully with personnel, residents, families, visitors, government agencies/personnel, and the public.
Must be knowledgeable of nursing and medical practices and procedures as well as laws, regulations and guidelines that pertain to long term care.
Must possess leadership and supervisory ability and the willingness to work harmoniously with and supervise other personnel.
Must have patience, tact, a cheerful disposition and enthusiasm, as well as the willingness to handle difficult residents.
Must be willing to seek out new methods and principles and be willing to incorporate them into existing nursing practice.
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.