- Conduct and maintain documentation of monthly and quarterly government beneficiary reimbursement reviews and case manager communications files to support maximization of reimbursement within government payor protocols
- Conduct community site visits to provide team member training on government reimbursement processing protocols to include accurate completion of applicable Customized Living tools
- Create and maintain community beneficiary case manager communications files and case manager contacts information
- Communicate and collaborate with community team members and Medicaid case managers in support of timely and accurate reimbursement
- Complete annual reviews of Medicaid beneficiary comprehensive assessments and service plans to identify areas of deficit(s) in assessments or documentation
- Train nurses at various levels of proficiency in management of government payor reimbursement protocols
- Audit, track, and trend government beneficiary reimbursement metrics for impact on quality resident services delivery and regulatory compliance with reimbursement protocols and opportunities for process improvement
- Participate in corporate and community level government reimbursement associated quality initiatives to include initiatives targeting timely and accurate completion of comprehensive and customized living tool assessments and service plans
- In collaboration with Director of Quality and Compliance, timely remediate identified process improvement needs to include perceived irregularities in documents necessary to support government reimbursement
- Draft biannual and annual government payor reimbursement reports for review by community, district, and executive leadership
- Collaborate in the development and/or improvement of government reimbursement team member training materials
- Minimum of one (1) year experience with Medicaid reimbursed services including completion of Medicaid Rate Sheets
- Experience working with government payor case management, such as Elderly Waiver and CADI, and/or completing Rate Sheets
- Proficient clinical assessment and documentation skills
- Strong interpersonal and organizational skills with the ability to work independently as well as collaboratively
- Proficient in working with electronic health records
- Previous experience as a trainer preferred
- Proficient in working in Excel preferred
- Proficient in written and verbal communication
- Ability to travel to complete site visits (Travel anticipated at 30-40% with minimal overnight stays)
- Medical, Dental, & Vision Insurance
- 401(k) with Company Match
- Paid Time Off and Holidays
- Company-Paid Basic Life Insurance
- Voluntary Short-Term Disability
- Company-Paid Long-Term Disability
- Health Reimbursement Account/Health Savings Account
- Flexible Spending Accounts
- Education assistance - up to $5,000 per calendar year
- Leadership Development & Career Advancement
- Real-time Access to Earned Wages
- Referral Bonuses
- Employee Assistance Program
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Clinical Reimbursement Manager - Hopkins, United States - New Perspective Senior Living LLC
Description
Job Description
Job DescriptionWhy New Perspective Senior Living? A career with a purpose starts here
This is an exciting time to join New Perspective. We are a growing company serving over 2,000 seniors today with a goal of reaching 10,000 by 2025. Our growth is creating energy, excitement, and the opportunity to make a difference in the lives of others. We have a culture of servant leadership and collaboration that supports each team member's personal and professional development. At New Perspective you're not just an employee, you are a valued member of our team.
The Clinical Reimbursement Manager ("CRM") provides oversight and direction to Community team members in creating and maintaining accurate documentation that supports billing for resident beneficiaries of Medicaid government assistance. Working in collaboration with the Director of Quality and Compliance, the CRM provides training, auditing, and oversight of clinical assessments and associated documentation conducted and maintained by Community licensed nurses in support of receipt of reimbursement for services identified within prescribed government payor reimbursement protocols.
Responsibilities
Qualifications
Team Member Benefits & Perks*
*Benefits vary by full-time, part-time, and PRN status.
New Perspective is an Equal Opportunity Employer.
