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Clinical Reimbursement Specialist - LPN

Company: Vi Living
Location: Alviso
Posted on: February 10, 2024

Job Description:

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. Key Competencies:
      • 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 confidentiality requirements.
      • Excellent knowledge of case-Mix, and the Federal Medicare PPS process as required.
      • Thorough understanding of the Quality Indicator Process, and OBRA regulations.
      • 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 $46.45 /Hr.

Keywords: Vi Living, San Francisco , Clinical Reimbursement Specialist - LPN, Healthcare , Alviso, California

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