Clinical Reimbursement Specialist - LPN
Company: Vi Living
Posted on: February 10, 2024
Overview: Vi is recognized as a Great Place to Work and one of
Glassdoor's 100 Best Companies to work for. Learn from the best and
accelerate your career with Vi.What We Offer:
- Competitive pay
- Exceptional benefits
- Generous Paid Time Off - start accruing on day one
- 401k with company match
- Paid maternity and paternity benefits
- Award-winning training and development
- Tuition Reimbursement
- Luxury work environment
- Meaningful and rewarding work Responsibilities: Clinical
Reimbursement Specialist (CRS) LPN/LVN Collaborates with the DON,
CRM (where applicable) and various disciplines to assist in the
completion of the Minimum Data Set (MDS), Resident Assessment
Instrument (RAI), and all associated processes. With guidance and
oversight from the DON or CRM (where applicable), the CRS ensures
completion of the assessment within the timeframe as mandated by
federal regulations and company policies. The CRS manages the
overall resident assessment process and tracking of all
Medicare/Managed Care/Medicaid case mix documents in order to
ensure appropriate and optimal reimbursement for services provided
within the Care Center. Responsibilities also include assisting
with the coordination of resident care planning processes under the
direction of the DON or CRM (where applicable). Performs other
duties as assigned. Performs duties in a timely and efficient
manner. This is a safety sensitive position. Principal
Accountabilities / Essential Job Functions: Reviews the clinical
records, MD progress notes, therapy and nursing documentation in
order to capture all care and services for optimal reimbursement.
Ensures that participants in the assessment process complete an
accurate and comprehensive assessment. Tracks Medicare/Managed Care
Beneficiaries to determine continued and appropriate Medicare
eligibility and benefit period by determining skilled level of
need. Performs concurrent and ongoing MDS review to ensure
appropriate PDPM category is achieved through the capture of
appropriate clinical information. Manages the coordination of
ICD-10 coding for Medicare and Managed Care billing. Directs the
interdisciplinary team process to communicate opportunities to
ensure capturing of all care, services, and diagnosis. Coordinates
with rehabilitation services Program Director, Corporate Director
of Clinical Reimbursement and Central Billing Office as needed to
communicate case mix data required for accurate claim billing at
month end. Reviews additional document requests by local Medicare
Administrative Contractors, insurance carriers or auditors to
ensure appropriate documentation is submitted timely for review.
Encourages staff to report changes in the resident's status and
involves the DON and CRM (where applicable) in addressing
concerns.Completes resident assessment protocol documents within
LPN/LVN scope of practice. Assists with the completion of the
resident care plan and the care plan conferences per requirements
with supervision and guidance from the DON or CRM (where
applicable). Provides resident and family education within LPN/LVN
scope of practice. Identifies and reports deviations from safe
practice to the DON or CRM (where applicable). Adheres to policies
and guidelines of regulatory agencies (i.e. OSHA, CMS). Manages
emergency situations based on the Companys safety and disaster
policies. Participates in quality assessment/performance
improvement activities and audits as assigned and overseen by the
DON or CRM (where applicable). Maintains minimum data set
competencies and attends annual educational programs.
Attends/participates in care center meetings, in-services and
committee meetings. May perform CPR, use Automated External
Defibrillator (AED), and render first aid in emergency situations.
Qualifications: Education and Experience:
- Education: Graduation from a School for Licensed
Practical/Vocational Nursing is required.
- Experience with MDS is REQUIRED
- Work Experience: Minimum 1 year of previous experience in an
MDS/Clinical Reimbursement Nurse role is preferred.
- Licensure / Certification, where required: Current State
Licensure as a Licensed Practical/Vocational Nursing in the state
where practicing is required. Current CPR and Automated External
Defibrillator (AED) certifications are required. Current First Aid
certification is required or must be willing and able to become
First Aid certified. Food handlers certification, where required.
- Maintains a courteous and professional manner through
interactions with others.
- Uses a resident and customer-focused approach to problem
solving and goal setting.
- Uses discretion in handling confidential information,
incorporating all Federal, State and local privacy and
- Excellent knowledge of case-Mix, and the Federal Medicare PPS
process as required.
- Thorough understanding of the Quality Indicator Process, and
- Must possess knowledge of regulatory compliance and Continuing
Care Retirement Community operations.
- Good oral and written communication skills and ability to
interface and maintain effective relationships with all departments
and employees in a team-oriented environment.
- Computer proficiency using Microsoft Office.
- Must be sensitive to the needs of older adults and enjoy
working with a senior population. Pay Range: USD $37.17 - USD
Keywords: Vi Living, San Francisco , Clinical Reimbursement Specialist - LPN, Healthcare , Alviso, California
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