Clinical Reimbursement Coordinator Resume Samples

Description :

1. Responsible for reviewing OASIS assessments, coding and sequencing diagnoses in accordance with medicare guidelines, instructing nurses regarding assessment strategies and medicare guidelines.
2. Served as a mentor for less experienced nurses and provided leadership in the field and the office.
3. Mastered ICD-9 coding and clinical reimbursement.
4. Provided administrative assistance, as needed, including scheduling follow-up appointments or providing clinical updates to payors, as needed Initiates efficiency initiatives for durable medical delivery process. (EF).
5. Provided front-line problem resolution to straightforward questions or customer service needs. 
6. Provided guidance to payors/ancillary partners and/or CM Representatives on service standards and service recovery. 
7. Partnered with leadership to implement best practices to deliver unparalleled service. 

Experience

10+ Years

Level

Senior

Education

BSN In Nursing

Description :

1. Worked for Glenwood Healthcare, Inc.
2. Assisted the Administrator in day to day functions of the facility.
3. Included scheduling of MDS's to maximize RUG utilization, conducting PPS meetings, working closely with the Therapy department to enable residents to attain highest level of function possible and month-end billing through the triple check process.
4. Worked with hospitals, physicians, and other skilled nursing facilities to evaluate patients for appropriate placement to the facility and discharge planning, as appropriate.
5. Tracked and trended service failures. Articulates and takes action for service gaps to leadership and along with recommendations for improvement. 
6. Collaborated with the leadership team to develop strategies to maximize efficiency and remove barriers to ensure effectiveness of post-acute care referrals or minimize denials or delays.
7. Participated in action plans for transition of care/discharge questions for patient satisfaction. 

Experience

5-7 Years

Level

Executive

Education

MS

Description :

1. Directed interdisciplinary team in related processes for MDS 2.0 completion for assigned 39 beds (see description under Kindred).
2. Scheduled all required MDS assessments, facilitated electronic transmission & verification of assessments & reports to State, & managed communications with payor sources, submitting documentation as requested for authorizations & monitoring for eligibility or changes requiring case-mix adjustment.
3. Earned certification as Resident Assessment Coordinator.
4. Participated in the on-call rotation for facility staff coverage.
5. Resigned to accept new position after unable to resolve scheduling in violation of hiring agreement with administration.
6. Initiated, directed, maintained Medicare PPS/OBRA assessments and schedules.
7. Negotiated all rates, level of care on one time contracts for managed care patients.

Experience

5-7 Years

Level

Executive

Education

Associates In Science

Description :

1. Led assesment coordinator for Medicare and assist in manage care assessment.
2. Performed progress reviews on each resident.
3. Assisted with discharge planning, DME and special needs.
4. Ensured proper clinical reimbursement and management of care to balance the resident and companies needs.
5. Directed a department and with oversite in Managing and capturing the best clinical reimbusement for PPS, while maintaining the federal guidelines and producing the best clinical picture and reimbursement for the facility.
6. Provided, assessed and assisted in the medical needs of the patient.
7. Managed the overall process and tracking of all Medicare/Medicaid case-mix documents in order to maximize reimbursement for services provided within the Center.

Experience

5-7 Years

Level

Executive

Education

LPN In Nursing

Description :

1. Coordinated the day to day operations of market Clinical Education Service Line, including coordinating nursing student placement and schedules and facilitating communication with clinical education employees. 
2. Sought and implemented strategies for operational improvement.
3. Supported clinical educators in scheduling classes, and ensures scheduled classes are properly set up with applicable education materials and equipment.
4. Supported the efforts of market and hospital personnel by providing prompt, accurate information necessary for the hospital to maintain accreditation standards of the Joint Commission, Medicare, Medicaid, and similar organizations.
5. Served as the HealthStream administrator for the market, including building e-learning classes, maintaining student groups, entering data, and providing reports as needed.
6. Provided timely, accurate, and professional support to the clinical education team. 
7. Managed and distributed data reports referencing quality, education, and patient experience.

Experience

7-10 Years

Level

Management

Education

M.S. In Health Care Administration

Description :

1. Provided staff training/in-service as related to patient care and needs.
2. Maintained accurate schedule for MDS completion to insure timely tranission to CMS as prescribed by regulations.
3. Conducted concurrent MDS reviews to assure the maximum allowable RUG categories, and monthly Medicare/Medicaid budget.
4. Identified opportunities to improve the customer experience. 
5. Contributed towards improving department scores for patient satisfaction on unit-based scorecard through peer-to-peer accountability.
6. Served as a role model for situational awareness, using teachable moments to improve safety. 
7. Participated in quality improvement initiatives and collects data for use in department performance improvement as directed. 

Experience

5-7 Years

Level

Executive

Education

MS

Description :

1. Provided leadership on the Department of Public Health's (DPH) strategic plan for health equity and public health impact initiatives.
2. Focused both on addressing inequities within DPH as an organization and externally in addressing health inequities in the St. Louis County region by collaborating with partners, stakeholders, and the community.
3. Used a data driven and evidence- and practice-based approach, in alignment with the department's strategic priorities, to provide technical expertise, project management, and leadership related to the development, implementation, and oversight of the health equity and impact plans.
4. Assessed, evaluated, and continually reported on the department's progress toward health equity and impact goals.
5. Identified grant and contract funding opportunities to advance DPH strategic priorities. 
6. Worked with DPH staff to align funding opportunities with program efforts and provide support in shaping grant applications with strategic priorities, goals, and activities of the department.
7. Identified emerging issues and support department staff in identifying strategic opportunities that would improve health outcomes and health equity.

Experience

2-5 Years

Level

Executive

Education

Bachelors

Description :

1. Administered the overall process and tracking of all Medicare/Medicaid case-mix documents in order to maximize reimbursement for services provided within the Center.
2. Managed MDS staff to ensure that MDSs are completed in accordance with both Federal and State Regulations.
3. Served as Manager on Duty on weekends to oversee facility operations and resolve staff/family issues.
4. Participated in daily meetings with the Interdisciplinary Team to ensure that residents are provided with quality health care.
5. Conducted staff training to improve the accuracy of documentation to maximize reimbursement.
6. Completed of MDS assessments as prescribed by law and all necessary forms, care plans, etc to insure all resident wants and needs are being met.
7. Contributed to identification of corrective action and improvement activities to meet department and hospital targets for quality and safety, collaborating with the interprofessional health care team.

Experience

7-10 Years

Level

Management

Education

M.S. In Health Care Administration

Description :

1. Supported the efforts of market and hospital personnel by providing prompt, accurate information necessary for the hospital to maintain accreditation standards of the Joint Commission, Medicare, Medicaid, and similar organizations.
2. Served as the HealthStream administrator for the market, including building e-learning classes, maintaining student groups, entering data, and providing reports as needed.
3. Provided timely, accurate, and professional support to the clinical education team. 
4. Managed and distributed data reports referencing quality, education, and patient experience.
5. Role modelled as a preceptor and implements staff education specific to patient populations and unit processes; coaches and mentors other staff. 
6. Functioned a resource for case management and social work resources and needs for the department and the hospital. 
7. Exemplified/led teamwork by responding positively to requests for assistance. 

Experience

7-10 Years

Level

Management

Education

Diploma

Description :

1. Fostered staff engagement by demonstrating active listening, requesting and acknowledging feedback, making equitable decisions, providing rationale when appropriate, and supporting organizational. (EF)
2. Arranged, expedited and completed acquisition of post-acute care needs or secures insurance authorization, as directed, confirming with social workers and case managers, and ancillary departments, based on physician orders, payor/reimbursement practices and regulations that may impact the patient's plan of care. (EF)
3. Facilitated designing and redesigning of CM representative processes and workflow. 
4. Actively participated in making recommendations for improving working relationships in the department, hospital, vendors, and post-acute providers. 
5. Led contributions with leadership to identify workflow opportunities, assisting with recruitment and retention efforts, including to improve employee engagement department scores for CM representatives through peer-to-peer accountability.
6. Provided necessary transfer/admission documentation. 
7. Reviewed for accuracy and completion. Supports clerical and clinical functions for patients, physicians and staff. 

Experience

5-7 Years

Level

Executive

Education

Bachelors