MDS Solutions - Clinical Reimbursement Specialist

MDS Solutions; Kansas City (MO); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a Clinical Reimbursement Specialist to join their remote team. In this vital role, you will support clients through specialized project work, including conducting RAI assessments and developing comprehensive care plans. Your expertise will guide healthcare agencies in optimizing their operations and ensuring compliance with regulations. This position offers the opportunity to make a significant impact by delivering targeted education and training, while also reviewing reimbursement systems for optimal outcomes. If you are a passionate professional with a strong clinical background and excellent communication skills, this role is perfect for you.

Qualifications

• Bachelor’s degree in nursing with 5+ years of clinical experience, including RAI specialization.
• Current RN license and RAC-CT certification required.

Responsibilities

• Serve as a trusted advisor to healthcare agencies, optimizing their operations.
• Deliver high-quality services encompassing reimbursement optimization and staff education.

Skills

Critical Thinking

Leadership

Interpersonal Communication

Clinical Judgment

Education

Bachelor's degree in Nursing

Tools

Resident Assessment Instrument (RAI)

PDPM Systems

Case Mix Systems

Job description

Overview

MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS division as a Clinical Reimbursement Specialist.

Clinical Reimbursement Specialist (CRS) plays a critical role in supporting clients through specialized project work, including conducting RAI assessments, developing comprehensive care plans, and delivering targeted education and training to MDS Coordinators on the Resident Assessment Instrument (RAI) process. This work is performed in strict alignment with applicable laws, regulations, and company standards. The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized reimbursement. Additionally, the CRS provides support with interim long-term and short-term contract coordination, ensuring the smooth completion of these efforts.

Responsibilities

• Serve as a trusted advisor to healthcare agencies and facilities, offering expert guidance and insights to optimize their operations.
• Assist clients in assessing, planning, developing, and implementing systems and processes related to reimbursement, tailored to the specific needs and contracts established with each client.
• Provide consulting services and technical expertise, including interim MDS management, ensuring providers receive the support they need to achieve optimal outcomes.
• Stay up-to-date on professional standards of clinical care, federal and state regulations, QM measures, and the RAI process to ensure the delivery of accurate, compliant, and effective solutions.
• Deliver high-quality, professional services that encompass reimbursement optimization, staff education, in-depth research, system analysis, creative problem-solving, and the presentation of actionable recommendations to clients.
• Identify and address training needs, developing and conducting training sessions or in-service programs as requested by clients to enhance staff competency and performance.
• Operate within the defined scope of work, maintaining strict adherence to client agreements and expectations.
• Uphold client confidentiality and ensure full compliance with HIPAA regulations, safeguarding sensitive information throughout the engagement.

Qualifications

Minimum Qualifications:

• Bachelor’s degree in nursing from an accredited college or university, with at least five (5) years of clinical experience, including 3+ years specializing in the RAI process.
• Current and unrestricted RN license, along with active RAC-CT certification, ensuring adherence to industry standards and best practices.
• Possesses exceptional critical thinking skills, with the proven ability to make informed decisions, demonstrate sound clinical judgment, and apply expert knowledge in quality improvement concepts and processes.
• Demonstrates strong leadership abilities and excels in interpersonal communication, fostering collaboration, and guiding teams to achieve optimal clinical outcomes.

Key Rehab is an equal opportunity employer/service provider.