Clinical Reimbursement Manager, RN

We Are Inspired to Serve. Join us! The Clinical Reimbursement Manager, RN, is a vital member of the healthcare team responsible for ensuring accurate and timely reimbursement for the services provided by the organization. This role requires a strong understanding of medical coding, billing practices, and healthcare regulations. This role works with the interdisciplinary team (nursing, therapy, dietary, social services, activities) to complete MDS assessments, analyze care areas, and develop and revise a comprehensive care plan to ensure that compliance is maintained with state and federal guidelines. This position is responsible for attesting to the completion of the Minimum Data Set (MDS) which is the key driver of the care plan, quality measures and used for Medicare payment and many Medicaid reimbursement systems. This role serves as the expert resource for the Patient-Driven Payment Model (PDPM) and is responsible for complying with ethical and timeliness standards when setting ARDs, completing assessments and upholding Medicare requirements. ESSENTIAL RESPONSIBILITIES: Coordinate the RAI process including MDS, Care Area Assessment process, Care plan development, Care plan implementation and Evaluation as prescribed by State and Federal regulations. Be knowledgeable of federal regulations, practice standards, procedures as well as guidelines pertaining to the RAI process. Provide oversight of assessment completion and transmission to the national repository. Review final validation reports and correct or modify assessment in response to warnings or errors as needed. Maintain the OBRA and PPS assessment schedules. Be highly involved in determining the skill level of care for Medicare residents and procuring required Medicare-specific documentation; be responsible for physician certification/recertification of a skilled level of care throughout the Medicare stay; be involved in making Medicare eligibility determinations. Coordinate care with Case managers for residents utilizing managed care, health maintenance organizations (HMOs) commercial insurance and other alternate payment models. Provide insight and analysis of MDS-based Quality Measures. Serve as a member of the quality assessment and assurance (QAA) and or quality assurance and performance improvement committees (QAPI). Work closely with hospital discharge planner and physician to obtain accurate and complete documentation to support ICD-10- CM diagnosis coding and surgical procedures. Participate in discharge planning, training, caregiver training and the provision of resources as needed. Foster effective working relationships and build consensus. Maintain confidentiality of sensitive information. Plan, organization, prioritize, and work independently to meet deadlines. Use judgement and make sound independent decisions. Work effectively with individuals at all levels of the organization, as well as residents, family members, visitors, government personnel and the public. EDUCATION AND WORK EXPERIENCE: Required Degree: Associate’s Degree in Nursing Preferred Degree: Bachelor’s Degree in Nursing; RAC CT Certification or RAC CTA Certification; ICD-10 Certification Course Preferred Certificate(s): RN License and CPR, if required by state Experience: 2 Years KNOWLEDGE, SKILLS, AND ABILITY: Have knowledge of current state and federal regulations, particularly the following pertinent sections of Appendix PP: - 483.20 Resident Assessments - 483.21 Comprehensive Resident-Centered Care Plans Knowledge of medical terminology to ensure correct coding and billing processes. The ability to comply with ethical and timeliness standards when setting ARDs, completing assessments, and upholding Medicare requirements. Additional traits are: Integrity, attention to detail, accuracy, time-management skills, ability to meet deadlines, critical thinking skills, written and verbal communication skills, care plan development skills and problem-solving skills PHYSICAL REQUIREMENTS: Ability to stand, sit, talk, reach, stoop, kneel, and use hands and fingers to operate a computer, telephone, and keyboard. Ability to lift, carry, push, and/or pull light to moderate amounts of weight up to 100 lbs. Ability to operate various equipment base on department. The ability to hear, understand, and distinguish speech and/or other sounds (e.g., machinery alarms, medical codes or alarms. Four hearing requirements listed: In person speech, Telephone, Other remote speech and other sounds. Clarity of Vision: For near visual acuity Clarity of vision at approximately 20 inches or less (i.e., working with small objects or reading small print), including use of computers. For far visual acuity, Clarity of vision at 20 feet or more. This is not just the ability to see a person or object, but the ability to recognize features as well. For peripheral vision, observing an area that can be seen up and down or to right or left while eyes are fixed on a given point. Compensation Pay Range: $42.11 - $53.96 per hour Reasonable Pay Estimate A reasonable estimate of the pay range for this position is $42.11 - $53.96 per hour. There are numerous factors taken into consideration in determining the actual offered rate of pay, including but not limited to: job-related qualifications, experience, skills, education, geographic location, and consideration of internal and external equity. For full time employees, we offer a generous benefits package that includes: Medical, dental and vision insurance Employer paid group term life and disability Paid Time Off (PTO) & six paid holidays 403(b) with a 3% employer match Fitness center use at most facilities. Various voluntary benefits: Life, AD&D Tuition assistance and scholarships Employee assistance program Legal services, home/auto insurance, discount purchasing program Pet Insurance For more information about Covenant Living and CovenantCare at Home, please visit www.covliving.org or www.covenantcareathome.org. Covenant Living and CovenantCare Home Health and Hospice are equal opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity or expression, religion, national origin or ancestry, age, disability, marital status, pregnancy, protected veteran status, protected genetic information, or any other characteristics protected by local laws, regulations, or ordinances. We believe we are a great place to work. Covenant Living & CovenantCare at Home are faith-based Continuing Care Retirement Community (CCRC) & Home Health organization. From the establishment of our first community – Covenant Home of Chicago in 1886 – to becoming the fifth-largest not-for-profit CCRC sponsor in the LeadingAge Ziegler Top 150, our goal has been to provide outstanding care and services to senior adults. We believe we are inspired to serve. We create joy and peace of mind for residents and their families by providing a better way of life. These are the standards of behavior we hold ourselves to in serving our residents. Safety I learn & follow safety policies & procedures. I immediately report unsafe conditions for staff, residents, & guests and fix when possible. I protect residents, co-workers, & myself from unsafe conditions and practices by reporting unsafe conditions and fixing it or having it fixed. Courtesy I smile & acknowledge everyone that I encounter. I carry myself in a manner that projects positivity, approachability, & respectfulness. I address the concerns of others by actively listening & seeking solutions. Responsiveness I take initiative to respond to the needs of others in a timely manner to achieve resolution. I anticipate the needs of others and respond in a timely manner. I communicate to others who need to join me in responding to the needs of others. I return phone calls within 24 hours. I identify action steps and communicate them to all vested parties. Image I ensure our environment is professional, welcoming, & clean. I follow CL policies, procedures, & all regulations. We believe in making a difference in other’s lives. We have approximately 3,200 employees serving more than 5,000 residents in our nationwide family of continuing care retirement communities and home health. Construction and development continues on several of our 14 campuses, ensuring ever more exciting opportunities for employees to serve residents.

Salary : $42 - $54