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Job: Clinical Reimbursement Specialist (RN) / Denial Coordinator

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Posted: 10/12/2017

Job Reference #: 1794

Job Type: Administrative/Clerical Healthcare - RNs & Nurse Management Human Resources - Comp & Benefits Healthcare - ALL CATEGORIES Human Resources - ALL CATEGORIES

Keywords: office,

Jobing Description

US-CO-Lakewood
Requisition ID
2017-1794
# of Openings
1
Category (Portal Searching)
Management

Overview

Vivage Logo

VIVAGE SENIOR LIVING, is a nationally recognized leader and innovator in the long-term care industry. VIVAGE SENIOR LIVING is dedicated to person-centered care and we embrace the Eden Alternative™ philosophy. We bring “quality of life in aging” and “living well” to Long Term Care!

Responsibilities

Currently, Vivage is seeking a Full-Time DENIAL COORDINATOR CLINICAL REIMBURSEMENT SPECIALIST.

The primary responsibility of the DENIAL COORDINATOR CLINICAL REIMBURSEMENT SPECIALIST is to coordinate and process Additional Documentation Requests & Denial appeals in all sites for all payers. This position will work in conjunction with other specialists to direct, coordinate and lead MDS/RAI Systems, Medicare A, Medicare B and all other insurance providers, as well as conduct care coordination for case management following the current federal, state and local standards, guidelines and regulations that govern long term care and assisted living facilities.

Incumbent is delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties to ensure appropriate reimbursement for services are provided within the Center.

Qualifications

  • Candidates will be a graduate from an accredited school of nursing or therapy with current license in the State of Colorado preferred.
  • Must have, as a minimum, three (3) years experience in an administrative supervisory capacity in skilled nursing with a strong understanding skilled nursing facility regulations.
  • Maintains strong working knowledge of the Resident Assessment Instrument (RAI) Manual as well as complete the required courses for credentialing through the American Association of Nurse Assessment Coordinators and maintain certification thereafter.
  • Prior CMS, Insurance, ADR and Denial appeal processing experience required.
  • Be able to assess residents and relate information regarding resident’s condition.
  • Must have knowledge of Medicare/Medicaid and insurance reimbursement procedures, contracts, clinical resource utilization and/or case management.
  • Must have basic computer operation and typing skills for efficient data input; must be able to navigate touchscreen computers.
  • Must have knowledge of office machines and equipment.
  • Must be able to read, write, speak and understand the English language.
  • Ability to make independent decisions when circumstances warrant such action.
  • Must possess the ability to deal tactfully when personnel, residents, family members, visitors, government agencies/personnel and the general public.
  • Knowledgeable of nursing and medical practices and procedures as well as regulations and guidelines that pertain to long term care.
  • Must have patience and enthusiasm, as well as, the willingness and ability to handle difficult residents.
  • Open to new ideas and be willing to incorporate them into practice.
  • Experience in rehabilitation and/or geriatric nursing is desirable.
  • Competence in supervision and leadership.
  • Ability to present and teach to a variety of audiences.
  • Must be knowledgeable of laws, regulations, and guidelines pertaining to hospital and nursing facility administrative procedures.
  • Must possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, etc., necessary for providing quality care and maintaining a sound operation.
  • Must be able to communicate policies, procedures, regulations, reports, etc., to personnel, residents, family members, visitors, and government agencies/personnel.
  • Must not pose a direct threat to the health or safety of other individuals in the workplace.

We are an Equal Opportunity Employer, Gender/Minority/Veterans/Disabled

No Agencies or Affiliates, please

 

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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