Regional Clinical Reimbursement Specialist - Full-Time

North Shore Health - Green Bay, WI

Job Title: Regional Clinical Reimbursement Specialist - Full-Time

Position: Nursing Specialist

Job Type:

Pay:

Shift:

Work Type:

Location

Address:

City: Green Bay

State: WI

ZIP Code:

Job Responsibilities

Provides leadership, oversight and acts as a resource for regional and facility staff specific to the RAI process, the Medicare program, and Medicaid Case Mix as applicable.
Conducts regular monitoring of facility Medicare and Case Mix management.
Works in coordination with the Regional Clinical Operations team to provide regional and facility interdisciplinary (IDT) teams with education and support for the development of systems to address and manage Quality Measures (QM) and the CMS Five Star Rating.
Supports accurate claims and billing.
Leads and participates in program improvement and development efforts related to the RAI, Medicare and Medicaid programs.
Conducts follow-up evaluations to validate those systems are functioning well after initial roll-out.
Identifies and evaluates trends as part of the Quality Assurance Process Improvement Program.
Assists with Root Cause Analysis.
Assists in identifying appropriate solutions.
Supports facility follow-up through appropriate measurement design.
Participates during the 'mock survey' process related to RAI with Regional Team as requested, and preparation for state and federal surveys as assigned.

Required Skills

Core Skills

Current license as a Registered Nurse issued by the State Board of Nursing (WI/ MN / ND / MI)
Minimum 3+ years’ experience with the RAI process
Strong Knowledge of PDPM and State Case Mix Reimbursement payment models
Effective verbal and written communication skills
Strong attention to detail and accuracy
Excellent organizational skills
Ability to prioritize, coordinate and simultaneously maintain multiple projects
Ability to work with minimal supervision and make independent decisions
Proficient in Microsoft Word, Excel, Power Point, and Internet navigation

Preferred Skills

Prior multi-facility experience
Customer service oriented
Approachable, flexible, and adaptable to change
High level of professionalism with the ability to maintain confidentiality

Requirements

Experience: Minimum 3+ years’ experience with the RAI process

Education: Bachelor’s degree or Associate degree in nursing from accredited college

License & Certification:

Current license as a Registered Nurse issued by the State Board of Nursing (WI/ MN / ND / MI)

Schedule:

COVID-19 Requirements: Not Specified

Benefits

Health insurance for full-time employees starting the first of the month following 30 days of employment
Dental and vision insurance for full and part-time staff
401(K) Program for full and part-time staff
6 paid holidays plus one floating holiday for full-time staff
Company paid life insurance for full-time staff
Voluntary life and disability insurance for full-time staff
Paid Time Off

Supplemental Pay

Not specified

Special Notes

Trust, engagement, competence, respect and passion are the values under which North Shore Healthcare operates every day.

Facility Details

Name: North Shore Health

Description: One of the leading employers and providers of post-acute care in the Midwest.

Specialties:

Not specified

Mission: To establish a culture that reinforces the values necessary to be the premier health services provider and employer in each of the communities we serve.