MDS Solutions - Clinical Reimbursement Specialist

About the role

The Clinical Reimbursement Specialist (CRS) plays a critical role in supporting clients through specialized project work, including conducting RAI assessments, developing comprehensive care plans, and delivering targeted education and training to MDS Coordinators on the Resident Assessment Instrument (RAI) process. This work is performed in strict alignment with applicable laws, regulations, and company standards. The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized reimbursement. Additionally, the CRS provides support with interim long-term and short-term contract coordination, ensuring the smooth completion of these efforts.

Responsibilities

• Assist clients in assessing, planning, developing, and implementing systems and processes related to reimbursement, tailored to the specific needs and contracts established with each client.
• Provide consulting services and technical expertise, including interim MDS management, ensuring providers receive the support they need to achieve optimal outcomes.
• Stay up-to-date on professional standards of clinical care, federal and state regulations, QM measures, and the RAI process to ensure the delivery of accurate, compliant, and effective solutions.
• Deliver high-quality, professional services that encompass reimbursement optimization, staff education, in-depth research, system analysis, creative problem-solving, and the presentation of actionable recommendations to clients.
• Identify and address training needs, developing and conducting training sessions or in-service programs as requested by clients to enhance staff competency and performance.
• Operate within the defined scope of work, maintaining strict adherence to client agreements and expectations.
• Uphold client confidentiality and ensure full compliance with HIPAA regulations, safeguarding sensitive information throughout the engagement.

Requirements

• Bachelor’s degree in nursing from an accredited college or university, with at least five (5) years of clinical experience, including 3+ years specializing in the RAI process.
• A current and unrestricted RN license, along with active RAC-CT certification, ensuring adherence to industry standards and best practices.
• Possesses exceptional critical thinking skills, with the proven ability to make informed decisions, demonstrate sound clinical judgment, and apply expert knowledge in quality improvement concepts and processes.
• Demonstrates strong leadership abilities and excels in interpersonal communication, fostering collaboration, and guiding teams to achieve optimal clinical outcomes.

Qualifications

• Minimum of three (3) years of experience in a healthcare setting, preferably in a rehabilitation facility.
• Experience with the RAI process and familiarity with PDPM and Case Mix reimbursement systems.
• Strong understanding of regulatory requirements and compliance with HIPAA.
• Excellent organizational and time management skills.
• Ability to work independently and manage multiple tasks simultaneously.
• Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint.

Skills

• Strong analytical and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to work effectively in a team environment.
• Knowledge of reimbursement systems and processes.
• Experience with data analysis and interpretation.

Benefits

Our comprehensive benefits package includes:

• Competitive salaries with bonus opportunities.
• Adequate opportunities for promotion, transfer, and advancement.
• High job satisfaction due to meaningful and fulfilling work.
• Reasonable working hours promoting work-life balance.
• Continuing education (CE) opportunities for ongoing professional development.
• Generous paid time off.
• Comprehensive health, dental, and life insurance packages.
• 401K with discretionary matching.
• Mileage and licensure reimbursements.
• Flexible Spending Account (FSA) and Health Savings Account (HSA) options.

Pay

Competitive salaries with bonus opportunities.

Schedule

Reasonable working hours promoting work-life balance.