Clinical Reimbursement Coordinator

Clinical Reimbursement Coordinator – Livingston, NJ

Salary Range: 76k-120k

The Clinical Reimbursement Coordinator assures the implementation of company policies and procedures pertaining to Medicare and managed‑care reimbursement in the facility. This position reports to the Administrator of the facility and receives consultative assistance from the Regional Clinical Reimbursement Specialist. The Coordinator is also responsible for regulatory compliance and quality‑improvement efforts in order to attain appropriate Medicare or managed‑care reimbursement. The role integrates information from all necessary disciplines to maintain accuracy and compliance with the MDS process.

By conducting concurrent MDS reviews, the Coordinator ensures the achievement of maximum allowable RUG categories. Working collaboratively with facility team members, the Coordinator ensures that services offered meet or exceed federal, state and company standards and serves as a role model for ethical business practices.

• Maintain a professional standard of behavior when interacting with staff, resident family members or visitors
• Follow and uphold the company Code of Conduct
• Facilitate daily PPS and weekly Medicare meetings
• Knowledge of and compliance with HIPAA guidelines
• Knowledge of and ability to download reports from Point Right
• Knowledge of and ability to download state and federal reports from the internet
• Participate in monthly billing reconciliation meetings
• Complete MDS reports per schedule as required for Medicare, managed‑care and OBRA schedules
• Initiate/update care plans as required
• Ensure compliance with state, federal, and Point Right transmissions and make modifications as needed
• Facilitate and coordinate with other disciplines to maintain care‑plan development and ongoing updates per MDS schedule
• Provide updates as required per managed‑care contract guidelines
• Communicate promptly with facility team/regional consultant any issues or concerns
• Completion and issuance of denial letters, coordination of Medicare certification completion, review of skilled nursing documentation (including CNA documentation) to support skilled needs
• Serve as the central resource for MDS/PPS and state Medicaid reimbursement
• Manage Medicare appeals process and participate in Administrative Law Judge hearings as needed
• Implement and participate in company processes developed to appropriately maximize reimbursement

• Graduate of an approved RN program
• Current RN license in the state and credentials as required
• Prior experience in Medicare reimbursement and/or MDS experience preferred
• Knowledge of managed‑care reimbursement systems
• Word‑processing and computer skills
• Excellent oral and written communication skills
• Excellent ability to maintain an effective, friendly working relationship with others
• Basic mathematical ability; ability to use a calculator
• Knowledge of quality‑improvement process, how it affects the 5‑Star report, and ability to identify issues or trends and implement corrective‑action plans as needed
• Knowledge of the 5‑Star report
• Excellent attention to detail; well organized
• Ability to provide one‑on‑one or small‑group education related to identified areas of need

We are proud to offer the following benefits to part‑time (22.5+ hours/week) and full‑time employees:

• Comprehensive Health Care Benefits
  • Multiple Medical Plans
    • Including Pharmacy
    • Including Teladoc
  • Multiple Dental Plans
  • Vision Plan
  • Health Savings Account (eligibility restrictions apply)
  • Flexible Spending Accounts
  • Voluntary Life and AD&D
  • Short‑Term and Long‑Term Disability Plans
  • Hospital Indemnity Insurance
  • Critical Illness Insurance
  • Accident Insurance
  • Whole Life Insurance
  • Medicare Employee Assistance
• Legal Plan
• Commuter Benefits
• 401(k) Retirement Plan
• Employee Assistance Program (available to all employees)
• Paid Time Off
  • Vacation
  • Sick Plans in accordance with state laws
• Opportunities to advance and grow your career

The Care One mission is to define excellence within the health care community. We are dedicated to maximizing patient outcomes and treat residents, their families and each other with respect, dignity and compassion. Through a collaborative and consultative approach, we strive to provide a framework of strength and stability for our centers and communities, maintaining the highest standards of care and service.

We are an Equal Opportunity Employer. EEO/AA/M/F/DV