Clinical Reimbursement Specialist

*The Alumus family of companies is comprised of Santé, Aleca Health, Alanté Health, and Encore*.
We're a premier provider of integrated healthcare solutions, serving our communities in Arizona, Oregon, and Washington.
We deliver comprehensive services including senior living, skilled nursing, palliative care, hospice, home health, primary care, telehealth, chronic care management, and more.
Alumus is dedicated to improving lives, reducing costs, and making quality healthcare accessible to everyone.
*We're seeking a Clinical Reimbursement Specialist for our growing team!* *This is a hybrid position:* * *Regular schedule offers the flexibility to work at our Operations office in Scottsdale *_*and*_ *remotely from home.
* * *Some travel to our local Santé facilities with minor travel to OR and WA required.
*_*Mileage reimbursement and covered out of state travel*_ *We offer* * *Excellent compensation package!* * *Mileage reimbursement and covered travel expenses* * *Comprehensive benefits coverage effective the 1st of the month following start date* * *Employee referral bonus Program* * *Generous PTO* * *Tuition reimbursement* * *IT equipment* *Position Summary* The Clinical Reimbursement Specialist (CRS) will be responsible for ensuring accurate assessments, coding, and timely reimbursement for healthcare services provided by our TRC and Home Health divisions.
The CRS should have a strong understanding of Payment systems, Medicare regulations, Managed care rules, and reimbursement processes, exceptional analytical skills, and excellent communication abilities to collaborate effectively with internal teams and external agencies.
*Essential Job Functions* Coding and Billing: * Ensure business entities accurately code and bill Medicare, Managed Care, and other Insurance claims for services rendered.
* Ensure compliance with Medicare, Managed Care, and other insurance billing regulations and guidelines.
* Review and analyze medical records to verify proper coding, assessments, and documentation.
Review Claim Submission and Follow-up: * Review prepared and submitted claims promptly.
* Coordinate with the billing team to ensure proper monitoring and tracking of claim status; identifying and resolving any issues that may delay reimbursement.
* Collaborate with Medicare Administrative Contractors (MACs) and other relevant agencies to resolve claim discrepancies.
Reimbursement Analysis: * Conduct reimbursement analysis to identify discrepancies, underpayments, or overpayments.
* Develop and Implement strategies to achieve accurate reimbursement while adhering to Medicare rules, Managed Care, and other Insurance rules and regulations.
* Documentation and Record-keeping * Oversee entities to ensure accurate and organized records of all reimbursement related transactions and communications are kept.
* Ensure compliance with record-keeping requirements set forth by Medicare, and other Payers.
Regulatory Compliance: * Stay updated on changes in Medicare, Managed Care, and other Insurance regulations and policies.
* Ensure the organization's practices and procedures align with current guidelines.
Collaboration and Communication: * Work closely with healthcare providers, billing staff, and other internal teams to resolve reimbursement-related issues.
* Communicate with Medicare, Managed Care, other Insurance representatives and other external entities as needed.
Reporting: * Generate regular reports on audit results and findings, reimbursement activities, claim denials, and financial performance for management review *Candidate Profile* * _*Must have prior experience in Medicare reimbursement and medical billing in SNF or Home Health.
*_ * *Bachelor’s degree required* (*nursing or healthcare administration highly preferred)* * *Minimum 1 year experience with PDPM* *(Patient-Driven Payment Model) and PDGM (Patient-Driven Groupings Model) required.
* * *Strong Knowledge of MDS, OASIS, and assessments.
Certifications in MDS or OASIS preferred.
* * *Strong knowledge of Medicare, Manage Care regulations and guidelines.
* * *Ability to travel to and from locations.
Mileage reimbursement is included.
* Alumus is an equal opportunity employer.
We celebrate diversity and are committed to creating an inclusive environment for all employees.
Job Type: Full-time Pay: From $100,000.
00 per year Benefits: * 401(k) * 401(k) matching * Dental insurance * Disability insurance * Employee assistance program * Flexible schedule * Flexible spending account * Health insurance * Life insurance * Paid time off * Tuition reimbursement * Vision insurance * Work from home Schedule: * Monday to Friday Education: * Bachelor's (Required) Experience: * SNF or Home Health Medicare Reimbursement or Billing: 1 year (Required) * PDPM and PDGM: 1 year (Required) Willingness to travel: * 50% (Required) Work Location: On the road