REGIONAL CLINICAL REIMBURSEMENT SPECIALIST - SOUTH CENTRAL TEXAS (72143)
Summary
Travels daily to healthcare facilities in South Central Texas to review medical records, ensure regulatory compliance, and support clinical reimbursement processes for resident care.
Regional Clinical Reimbursement Specialist
As a Regional Clinical Reimbursement Specialist, you will travel daily to facilities in your Region to promote, plan, organize, develop, coordinate, and direct our facility teams in support of Clinical Reimbursement in accordance with State and federal regulatory requirements and our company’s established policies and procedures to assure that the highest degree of quality resident care and safety be maintained.
You will work under the direction of the Director of Clinical Reimbursement and be responsible for the executive oversight of the administration, clinical planning, development, and operations of the MDS program. This position supports regional and facility employees in all aspects of care management.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Medical records review utilizing clinical and regulatory knowledge to determine required supporting documentation
- Clinical nursing review of patient records for compliance with facility practices and procedures as directed
- Flexibly manage tasks to meet deadlines by re-prioritizing workflows in a production-oriented setting
- Employ critical thinking to identify/resolve issues and provide timely feedback regarding medical review processes
- Develop appeal arguments using clinical evidence, supporting references/regulations, and participate in appeal hearings by providing testimony, as required
- Determine regulatory and clinical support for appeal arguments when pre-existing resources are unavailable
- Proficiently review and synthesize abstract information from handwritten/electronic medical records to support claims
- Agree not to disclose assigned user ID code and password for accessing resident/facility information and promptly report suspected or known violations of such disclosure to the Director of Medical Records.
- Agree not to disclose resident’s protected health information and promptly report suspected or known violations of such disclosure to the Director of Medical Records.
- Report any known or suspected unauthorized attempt to access facility’s information system to Director of Medical Records.
- Attend and participate in mandatory in-service training programs, workshops, seminars, etc., as approved / delegated.