Clinical Reimbursement Specialist (MDS Coordinator)
Orlando Health

Job DetailsCompany Overview

The Clinical Reimbursement Specialist is responsible for

assisting Resident Assessment Instrument (RAI) 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 and Part B 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

• Initiates and completes discharge and re-entry tracking for ms accurately and timely.

• Performs modifications of assessments in accordance with CMS Correction Policy.

• Verifies timely transmission of MDS assessments, including tracking forms to the State

in accordance with standards.

• Other duties as assigned

Recommended Skills

• Medicare
• Case Management
• Assessments
• Medicaid
• Computer Literacy
• Communication

Get job alerts by email.Sign up now!

This job has expired.