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Registered Nurse - Clinical Reimbursement Director (Minimum Data Set Coordinator)
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Registered Nurse - Clinical Reimbursement Director (Minimum Data Set Coordinator)

Job Snapshot

Employment Type Full-Time
Job Type Nurse
Education Not Specified
Experience At least 3 year(s)
Manages Others Not Specified
Industry Healthcare - Health Services
Required Travel Not Specified
Job ID Tampa - CRD

Job Description

Rehabilitation & Healthcare Center of Tampa has been serving the Hillsborough County area for over 40 years. Our 174 bed facility is located close to local hospitals.

We provide post-acute services, rehabilitative services, skilled nursing, short and long term care through Physical, Occupational, and Speech Therapists; Registered and Licensed Practical Nurses; and Certified Nursing Assistants. This is complemented by Social Services, Activities, Nutritional Services, Housekeeping and Laundry Services. With over 60 years of combined experience, our staff of professionals is here to meet the needs of each and every patient and resident.

 

For those residents who can no longer be on their own and need long term care we offer general nursing and restorative services in a warm and home like environment.


The Clinical Reimbursement Director (Minimum Data Set Coordinator) is responsible for the coordination of the "Resident Assessment Instrument" process to ensure accurate and timely completion of resident assessments in accordance with Medicare, Medicaid, OBRA and other payor program requirements.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Case Management

Manages Medicare Part A certification process.

 

Performs ongoing evaluations from pre-admission through discharge to ensure an appropriate reimbursement level for each resident. Evaluates care to ensure that services and products match benefits available

 

Reviews medical records, care plans, charting to ensure documentation supports care provided and reimbursement level.

 

Monitors facility practice to ensure compliance with guidelines for participation in Medicare, Medicaid and other benefit programs. Initiates action needed to ensure compliance.

 

Participates in quad check prior to release of claims. Tracks and reviews all claim denials to identify problems.

 

Assists in preparation and timely submission of any additional development requests, reconsiderations and administrative law judge hearings.

 

Review state MDS validation reports to identify issues and or processes to ensure accuracy of submitted MDS’s.

 

Responsible for evaluating and providing education, intervention and support for Medicare, PPS, RAI, state specific and special contract reimbursement.

 

Manage the overall process of reimbursement for the facility.

 

Track all Medicare/Medicaid case-mix documents in order to assure appropriate reimbursement for services provided within the facility.

 

Other duties as assigned.

RAI Process

Participates in the pre-admission process to ensure essential information needed for MDS/Case mix optimization is obtained from the referral source.

 

Works in collaboration with Rehab Program Coordinator to ensure the most appropriate assessment reference date is utilized for assessments.

 

Lead and manage Clinical Reimbursement Specialist(s) in a matrix Management environment.

 

Performs modifications of assessments in accordance with CMS Correction Policy.

 

 



 

Job Requirements

As a team member we require that you be a FL-licensed Registered Nurse with strong clinical expertise, and in return we will offer you very competitive compensation and benefits, exceptional; tenured leadership from the Support Services Center as well as from the facility Administrator, Director of Nursing, and field-based Regional and Consulting teams; a stable and professional environment; and a progressive facility where resident and patient care comes first.

To be considered we ask that you also meet the following minimum criteria:

  • FL-licensed Registered Nurse - REQUIRED
  • 3 years of Clinical Reimbursement/Minimum Data Set experience - REQUIRED
  • Excellent customer service skills; dedication and commitment to providing excellent healthcare services to our residents and patients
  • Excellent ability to operate effectively and efficiently in an enthusiastic, team-oriented work environment
  • exemplary customer service skills, especially as it pertains to residents, patients and family members
  • the ability to artfully and factually develop and implement care plans, and communicate said care plans to appropriate parties
  • comprehensive knowledge of Medicare and Medicaid reimbursement
  • ability to quickly recognize and identify symptoms and make decisions based on changes in acuity level
  • exceptional orgnaization skills and detail-oriented



If you are interested in pursuing an exceptional career opportunity in a facility where resident and patient care comes first, then please send an updated resume to [Click Here to Email Your Resumé]

Rehabilitation & Healthcare Center of Tampa is
an Equal Opportunity Employer and a Drug-Free workplace

View More Job Details

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Registered Nurse - Clinical Reimbursement Director (Minimum Data Set Coordinator)


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