SanStone Health & Rehabilitation · 1 day ago
Regional Clinical Reimbursement Consultant Asheville Area
Buncombe County, NC
Full-time
Onsite
Mid Level
3+ years expSanStone Health & Rehabilitation is seeking a Regional Clinical Reimbursement Consultant to provide support, education, and training to MDS Coordinators on the Resident Assessment Instrument process. The role involves reviewing and coordinating PDPM and Case Mix data to ensure appropriate reimbursement and supporting facility staff in managing quality measures and compliance with Medicare and Medicaid programs.
Health CareHospital
Responsibilities
Provides leadership, oversight and acts as a resource for regional and facility staff specific to the RAI process, the Medicare program, and Medicaid Case Mix as applicable
Conducts regular monitoring of facility Medicare management and Case-Mix
Works in coordination with the Regional Nurse Consultant to provide regional and facility interdisciplinary (IDT) teams with education and support for the development of systems to address and manage Quality Measures (QM) and the CMS Five Star Rating
Supports accurate claims and billing
Leads and participates in program improvement and development efforts related to the RAI, Medicare and Medicaid programs
Conducts follow-up evaluations to validate those systems are functioning well after initial roll-out
Participates in the Quality Assurance Process Improvement Program:
Identifies and evaluates trends
Assists with Root Cause Analysis
Assists in identifying appropriate solutions
Supports facility follow-up through appropriate measurement design
Participates during “mock survey” process related to RAI with Regional Team as requested, and preparation for state and federal surveys as assigned
Qualification
Required
Current license as a Registered Nurse issued by the State Board of Nursing
Bachelor's degree or Associate degree in nursing from accredited college
Minimum 3 + years' experience with the RAI process
Strong Knowledge of PDPM and State Case Mix Time weighted Reimbursement payment system
Knowledgeable of the nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to long-term care
Effective verbal and written English communication skills
Ability to communicate at all levels of the organization and work well within a team environment in support of company objectives
Customer service oriented with the ability to work well under pressure
Strong attention to detail and accuracy, excellent organizational skills with ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity
Ability to work with minimal supervision, take initiative and make independent decisions
Approachable, flexible, and adaptable to change
Function independently, and have flexibility, personal integrity, and the ability to work effectively with employees and vendors
High level of professionalism with the ability to maintain confidentiality
Ability to travel
Preferred
Prior multi-facility experience a plus
Demonstrate basic to intermediate skills in Microsoft Word, Excel, Power Point, and Internet navigation, preferred
Company
SanStone Health & Rehabilitation
SanStone Health & Rehabilitation provides short-stay and long-term rehabilitative care to patients transitioning from the hospital back to their private homes.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Michael DeLoach
Co-Founder
Christopher Sprenger
Owner
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