CLINICAL REIMBURSEMENT COORDINATOR - RN/LPN

Essential Job Functions:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Perform independent and/or suggested affiliate level, clinical and financial audits as warranted.
• Identify and assist with educational opportunities through audit, tracking, trending, and analyzing relevant patient data with supervisor guidance and support.
• Strategic planning related to ARDs; optimizing the appropriate revenue systems.
• Ensure IDT compliance with state/federal requirements and timeframes related to MDS, billing and care planning.
• Interpretation of revenue related data as requested.
• Identify revenue related risks associated with missing, irrelevant, erroneous clinical documentation. Assist with action plans related to such risk as warranted.
• Assist with orientation and education for CRCs and other IDT members as relates to MDS and/or reimbursement processes.
• Provide ongoing education and communication with IDT as relates to current state and federal regulation systems driven by the MDS.
• Review clinical charts and assist with determination of ongoing skilled need, and appropriate Length of Stay.
• Under the coordination of a Registered Nurse, complete sections of the MDS.
• Review, revise and communicate the need for new care plans as per facility protocol.

• Attend CP meetings per facility protocol.
• Conduct/attend as necessary the daily, weekly, monthly meetings related to Revenue. (Daily REV, Wkly MRA/CMI, Monthly Triple check)
• Ensure/assist with the timeliness of managed care updates.
• Assist with maintenance, risk and education related to 5 STAR Quality Measures/Value Based Purchasing, and Quality Reporting programs.
• Provide information as requested for Additional Documentation Request (ADR) and appeals as appropriate.
• Other related duties as assigned.

Annual Salary:
LPN - $70,000-$80,000
RN - $85,000-$95,000