Clinical Reimbursement Manager

Description:
Could you be our next Clinical Reimbursement Manager-Utilization Review at HomeCare & Hospice?

Why work as a Clinical Reimbursement Manager with Main Line Health?

• Make an Impact! The Clinical Reimbursement Manager is responsible for overseeing and evaluating the services provided to home health clients to maximize clinical outcomes, financial profitability, and regulatory compliance. The Clinical Reimbursement Manager reviews all clinical assessment (OASIS) documentation and assess appropriate visit utilization patterns based on the care needs of the client and the reimbursement to be received by the agency for providing this care. The Clinical Reimbursement Manager makes these decisions by reviewing the gross profit margin of each client taken under care and the ability of the client/caregiver to support care in the home. This decision is reached in collaboration with the payor as needed. The Clinical Reimbursement Manager ensures the proper ICD-10 coding and sequencing of the diagnoses for the claim. The Clinical Reimbursement Manager oversees the progress of the client during the home health episode of care and monitors care events that may trigger a change in care needs. For assigned cases, the Clinical Reimbursement Manager reviews and signs all plans of care (Medicare form-485 orders) and service orders going to physicians. The Clinical Reimbursement Manager manages an average active caseload of 100-150 clients (1500 clients annually) and monitors the activity of 200 clinical staff.
  
  
• Join the Team! Like our patients, the Main Line Health Family encompasses a wide range of backgrounds and abilities. Just as each of our patients requires a personalized care plan, each of our employees, physicians, and volunteers, bring distinctive talents to Main Line Health. Regardless of our unique design, we all share a purpose: providing superior service and care.
  
  
• Position-Specific Benefits include: We offer a number of employee discounts to various activities, services, and vendors... And employee parking is always free!
  
  

Position: Clinical Reimbursement Manager-UR
Shift: Every other weekend day shift + holiday coverage

Experience:
1. Three to five year’s clinical experience with at least two years home care experience preferred.
2. Basic computer skills required, knowledge of home health information system a plus
3. Knowledge of Medicare regulations pertaining to Home Health, expertise in Home Health Coding preferred.

Education:
1. Graduate of an accredited School of Nursing required.
2. Associate’s degree required.
3. Bachelor’s degree preferred.

Licensures/Certifications:
1. Current licensure in the Commonwealth of Pennsylvania as a Registered Nurse required.
2. Home Care Coding Specialist - Diagnosis (HCS-D) Certification and Home Care Coding Specialist - OASIS (HCS - O) Certification preferred or will be obtained within 2 years of accepting the position.