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:
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.
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.