Clinical Reimbursement SpecialistAvalon Health Care Management Inc. • Salt Lake City, UT, United States

Clinical Reimbursement Specialist

Avalon Health Care Management Inc. • Salt Lake City, UT, United States

1 day ago

Job type

Full-time

Job description

Avalon Health Care Management, Inc. in SLC, Utah is seeking a confident leader to join us as a Clinical Reimbursement Specialist!

Full-time are eligible for :

401K
Medical, Dental & Vision
FSA & Dependent Care FSA
Life Insurance
AD&D, Long Term Disability, Short Term Disability
Critical Illness, Accident, Hospital Indemnity
Legal Benefits, Identity Theft Protection
Pet Insurance and Auto / Home Insurance.

Come join our team! We offer great challenges, a rewarding career and opportunities for advancement!

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.

Participates and contributes to the development of facility policies and procedures specific to clinical management systems related to the RAI.

Conducts regular monitoring of facility management systems for compliance with Avalon policies, procedures and best practices.

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.

Reports directly to the CNO and CRS.

Supports accurate claims and billing.

Provides analysis and participates in regular reviews of facility clinical and financial outcome data.

Leads and participates in program improvement and development efforts related to the RAI, Medicare and Medicaid programs.

Conducts follow-up evaluations to validate that 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 with Regional Team as requested, and preparation for state and federal surveys as assigned.

Qualifications

Licensed RN

At least two years of experience working in a long-term care setting.

Experience with RAI process and MDS certification preferred.

Knowledge and experience with Medicare technical and clinical coverage criteria, Prospective Payment System (PPS), and state Medicaid case mix requirements as applicable.

Must be available to travel frequently to facilities across the portfolio.

Must possess ability to effectively communicate with other health care professionals.

Must have adequate computer and keyboarding skills to allow use of electronic charting, billing and reporting systems.

Avalon Health Care Group is an Equal Opportunity Employer

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Reimbursement Specialist • Salt Lake City, UT, United States

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