Regional Reimbursement Analyst - Oregon State Region

Regional Reimbursement Analyst (RN)

Status: Full-Time

Location: Regional coverage for our SNFs in Oregon state

Job Summary

The Reimbursement Analyst is a key support staff member responsible for understanding governmental regulatory reporting needs. Serves as a resource for facilities on the RAI process, reimbursement (Medicare, Medicaid, OBRA and other payor programs) and Quality measures. Participates in the development of the QAPI and Acton Plans for the RAI process.

Essential Duties and Job Responsibilities

• Assists in the development and implementation of QAPI plans for clinical reimbursement and attends Regional QAPI meetings.
• Performs routine risk assessments for assigned facilities to determine risk and actionable plans.
• Coordinate with high-risk facilities and develop performance improvement plan.
• Coordinate with high-risk facilities and develop QRP performance improvement plan. Provides facility leadership Quality measure and QRP threshold reports.
• * Implement training for CMS/MDS changes and provide education to assigned facilities.
• Conducts routine audits of MDS coding to ensure accuracy and identify opportunities for process improvement.
• Assists in the orientation and training of new MDS coordinators on the RAI process, Federal and State regulations,
• Provides support to the facilities by assisting the Clinical Reimbursement Specialist in answering questions.
• Maintains current knowledge of reimbursement regulations.
• Maintains data in an organized, easily retrievable manner.
• Maintains good personal hygiene and follows dress code requirements.
• Communicates regularly with Administrator to discuss identified clinical reimbursement issues.
• Utilizes Clinical Reimbursement Department as resource and clarification over processes.
• Other duties as assigned or needed

Other Functions:

• Assist with preparation of materials utilized by the client organization as needed.
• Attend company meetings, event and planning sessions as needed; and
• Assist with other activities as directed by the CNO.

Successful incumbent employees must be able to perform the essential duties of the position to the satisfaction of the organization, with or without a reasonable accommodation.

Requirements and Qualifications

Minimum Requirements

• Must possess a current, unencumbered, active license to practice as a Registered Nurse in the state of Oregon or Washington.
• Must have a minimum of 2 years of experience with RAI process; 3 years' experience in Long Term Care and Skilled Nursing facility setting.
• Proficient in the RAI process, PDPM, QRP, VBP and 5-star rating
• Able to travel and if needed stay local to an assigned facility while functioning as the Interim MDS Coordinator
• Prior demonstrable experience developing, implementing and monitoring systems to ensure Organization compliance with federal/state requirements, RAI process.
• Excellent communication, presentation, and facilitation skills.
• Experience with Electronic Medical Records and computer documentation systems.
• Ability to learn, respect and respond to the different needs and challenges of the different business units.

Preferred Qualification

• CMAC certification.
• Five (5) years PCC or other equivalent Emar experience

Avamere Living is an Equal Opportunity Employer and participates in E-Verify.