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regional clinical reimbursement consultant resume example with 13+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
  • :
Summary

To obtain a position as a Director of Clinical Reimbursement. Efficiency-driven, highly accurate and well-organized with open and clear communication style and self-motivated approach.

Skills
  • Credential as a Resident Assessment Coordinator-Certified (RAC-CT) since 2013.
  • Exceptional organizational and time management with outstanding verbal and written communication skills.
  • Remarkable computer skills in Microsoft Word, Excel, Power Point, and Outlook, and Point Click Care.
  • Expert in SNF/LTC Reimbursement, system development and implementation of programs that apply to the Resident Assessment Instrument (RAI), Prospective Payment Systems (PPS), Patient Driven Payment Model (PDPM), Quality Measures (QM’s), Quality Reporting Programs (QRP's), Medicare/Medicaid guidelines, and state specific Medicaid Case Mix per CMS
Experience
Regional Clinical Reimbursement Consultant , 12/2021 to Current
EcumenLitchfield, MN,
  • Work directly with MDS Coordinators to enhance knowledge and skills to improve clinical outcomes, compliance, quality reporting, and correct coding, while ensuring the highest level of revenue integrity
  • Trending, tracking, auditing, and analyzing data for reimbursement and support of the coding of the MDS
  • Review of current reporting systems to audit facility MDSs and determine modifications needed as appropriate, as well as providing education to the facility on the reasons for the necessary modification
  • Highly involved in determining skilled level of care for Medicare/Managed Care residents as well as working with the admission teams to ensure appropriate primary diagnoses for new residents to support skilled care
  • Overseeing and auditing the completion of physician certifications of a skilled level of care throughout the Medicare stay
  • Provide oversight and analysis of MDS based Quality Measures
  • Participation in the hiring and training of MDS coordinators in multiple sites
  • Training and education of the facility team as it relates to current state and federal regulations for reimbursement and payment models for both PDPM and state specific Medicaid models and CMI
  • Maintain compliance with state-specific regulations regarding the RAI process
  • Knowledgeable of regulations, practice standards, and procedures, as well as laws, regulations, and guidelines pertaining to the RAI process and payment methodologies for all payers, including, but not limited to CMS and PDPM
  • Conduct regular facility visits to support the teams in each facility while providing a visit report to the regional team and the Corporate Director of Clinical Reimbursement
  • Complete monthly reporting of MDS concerns, staffing issues, average CMI for PDPM and Medicaid, at a minimum, by facility
  • Plan, organize, prioritize, work independently, and meet deadlines
MDS Coordinator, 02/2013 to 12/2021
Lake Country Health ServicesOconomowoc, WI,
  • Develop and maintain a weekly resident assessment schedule in accordance with CMS guidelines
  • Works closely with Rehab Manager on setting RUGs scores, reconciliation of scores, etc
  • Coordinate the interdisciplinary process with other team members and facilitate weekly Utilization Review meetings to determine necessity of continued stay or to identify any barriers to discharge planning.
  • Work with the Education Coordinator to develop and provide staff in-services regarding documentation for the MDS process
  • Coordinate the Utilization Review process in the Interdisciplinary Care Plan Team
  • Assigned ICD-10 codes to each resident according to physician and rehabilitation documentation.
Assistant Director of Nursing, 02/2010 to 02/2013
The Waters Of New CastleCity, STATE,
  • Work in collaboration with the Interdisciplinary Team to assess the needs of the resident
  • Coordinate and attend Interdisciplinary Team meetings in order to gather information, communicate changes, and maintain and update records and care plans
  • Assist with coordination and management of the daily care management meeting, to include review of resident’s current care and possible significant changes in health status.
  • Trained and supervised health care workers conducting direct resident care.
Education and Training
Associate Degree in Nursing: , Expected in 05/2023 to Ivy Tech Community College of Indiana - Anderson, IN ,
GPA:
Licensed Practical Nurse: Nursing, Expected in 12/2009 to Ivy Tech Community College of Indiana - Anderson, IN,
GPA:

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Resume Overview

School Attended

  • Ivy Tech Community College of Indiana
  • Ivy Tech Community College of Indiana

Job Titles Held:

  • Regional Clinical Reimbursement Consultant
  • MDS Coordinator
  • Assistant Director of Nursing

Degrees

  • Associate Degree in Nursing
  • Licensed Practical Nurse

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