RN Clinical Reimbursement Manager

Overview

$93,k per year
(Pay based on experience)

Keswick is located in Baltimore, MD. We are seeking dedicated, caring team members willing and able to commit to our workplace values:
Connection, Empathy, Inclusion and Advocacy!

Keswick was top-ranked for 2024 as High-Performing by U.S. News & World Report
, a rating only reached by 19% of nursing homes in the country.

Keswick was recognized on Newsweek's2023 and 2024 ranking of Best Nursing Homes in Maryland.

Keswick is a not-for-profit aging services organization dedicated to improving the experience of aging, together. With over 140 years of expertise, we have become a trusted leader in providing compassionate services for older adults in our community.

Why Choose Kes
wic?

Keswick employees are part of a compassionate, and award-winning team, working together to deliver top care to the people of Baltimore. When you join our team, you can expect:

Health and prescription coverage with lower-than-average deductibles and copays

Dental and vision benefits

Free short- and long-term disability coverage

Employer paid Life and AD&D Insurance for Full Time Employees (optional supplemental life insurance)

401(k) program with employer matching up to 6%

Generous vacation, sick, and holiday pay with an option to "cash out" unused vacation hours

MTA discounted bus passes

Teladoc
- Free 24-hour access to a physician

Employee Assistance Program with a variety of free services

Employee Recognition Program

Free access to our Employee Wellness Program
, such as Zumba and Pilates

As a Clinical Reimbursement Manager, you will carry out our mission to improve the experience of aging together by being primarily responsible for the of the Clinical Reimbursement Department and clinical recording in the MDS and related documents for the skilled nursing facility. This position is responsible for planning, organizing, and directing the overall operation of the department in accordance with current federal, state, and local standards, guidelines, and regulations governing skilled and long-term care.

• Oversees clinical reimbursement operations and ensures the collection of information (initial and ongoing) for the Minimum Data Set (MDS). Ensures the MDS coordinator team works with the nursing department for a comprehensive nursing assessment of the resident/patient health status.
• Demonstrates expertise in the completion of the MDS to capture services provided and facilitate optimal reimbursement. Ensures the appropriate MDS is completed timely for the various circumstances related to admission and quarterly assessments, interrupted stay, change of condition, etc.
• Works to identify coding that reflects the full patient condition and captures all appropriate ancillary and rehab conditions.
• Assures that documentation meets requirements of Keswick and regulatory agencies and is sufficient to support MDS coding as well as to substantiate reimbursement for Keswick services.
• Facilitates/assures process for managed care authorizations post admission, reviews contracts for compliance and seeks carve-outs and appropriate levels of authorized care.
• Oversees or directly participates in the triple check process with administration, rehab, and business office staff to ensure accuracy and regulatory requirements are met prior to billing.
• Meets with the rehabilitation director and personnel regularly to ensure documentation compliance and accuracy.
• Identifies recurring problems and communicates to appropriate staff for resolution.
• Provides support to state and/or federal surveys, as needed.
• Oversee the tracking system of MDS schedules (time frames and due dates)
• Seeks knowledge/clarification related to reimbursement regulation and MDS completion.
• Takes initiative to analyze the CASPER for potential areas of opportunity to improve clinical outcome measures for the Five Star Report and other clinical indicators. Works with the interdisciplinary team to develop action plans for improved capture of MDS documentation.
• Works to implement strategies to optimize Keswick's CMI as a reflection of documented services provided.
• Communicates and consults with other health team members.
• Prepares quality assurance reports and interprets/analyzes data for quality assurance purposes.
• Ensures timeliness of compliance with external audits; i.e., Telligen, pre/post payment reviews.
• Ensures timely completions of 3871s, Continued Stay Reviews, etc.
• Participates as an organizational leader and manager on-duty weekend rotation. Supports Keswick's overall mission, vision, and values.

• Registered nurse, licensed and in good standing with the Maryland Board of Nursing required.
• MDS experience is required.
• KNOWLEDGE OF:
  Resident Assessment Instrument (RAI) manual, nursing and rehabilitation practice and principles; applicable laws and regulations governing long-term care and/or sub-acute (short stay) care; reimbursement requirements; diseases, conditions and treatment therapies for the…