Clinical Reimbursement Specialist - Green Tree, PA
8 hours ago
Job description
About Us
Oakdale Seniors Alliance is a mission‑driven organization committed to delivering exceptional resident care while maintaining the highest standards of compliance, documentation integrity, and reimbursement accuracy. We believe in supporting our clinical teams, empowering growth, and providing compassionate, person‑centered services.
Position Summary
We are seeking a knowledgeable and detail‑oriented Clinical Reimbursement Specialist to join our reimbursement and clinical operations team. This individual will partner with the Director, Clinical Reimbursement to optimize the Minimum Data Set (MDS) process, ensure accurate clinical documentation, and support appropriate reimbursement under PDPM (Patient‑Driven Payment Model) and other payer systems.
The ideal candidate is a collaborative problem-solver with a strong clinical background, excellent analytical skills, and a passion for accuracy and compliance.
Key Responsibilities
- Complete, audit, and ensure accuracy of MDS assessments in accordance with federal/state regulations and company policies.
- Collaborate with interdisciplinary teams to ensure documentation supports coding decisions, PDPM classifications, and skilled service needs.
- Monitor and validate diagnosis coding, care area assessments (CAAs), and final RUG/PDPM scores.
- Provide ongoing education to clinical staff regarding proper documentation, reimbursement guidelines, and regulatory updates.
- Review clinical records for accuracy, completeness, and compliance with Medicare, Medicaid, and third‑party payer requirements.
- Participate in case-mix management, triple-check processes, and quality assurance initiatives.
- Track and analyze reimbursement trends, quality measures (QMs), and regulatory changes impacting skilled nursing reimbursement.
- Support survey readiness and compliance with all CMS regulations.
Qualifications
- Licensed Registered Nurse (RN) required.
- Minimum 2–3 years of MDS/Clinical Reimbursement experience in a skilled nursing facility.
- Strong knowledge of PDPM, Medicare/Medicaid regulations, ICD‑10 coding, and CMS RAI guidelines.
- Exceptional analytical skills and attention to detail.
- Ability to work independently and collaboratively across teams.
- Excellent organizational, communication, and time‑management abilities.
- Proficiency with MDS software systems and EMR platforms preferred.
What We Offer
- Competitive salary
- Comprehensive health, dental, and vision benefits
- Paid time off and 401(k)
- Supportive, team‑oriented environment with strong corporate compliance values
Oakdale Seniors Alliance is an Equal Opportunity Employer.
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