Clinical Reimbursement Manager

Full Time | Day Shift

Keswick is located in Baltimore, MD. We are seeking dedicated, caring team members willing and able to commit to our workplace values: Connection, Empathy, Inclusion and Advocacy!

Keswick was top-ranked for 2024 as High-Performing by U.S. News & World Report, a rating only reached by 19% of nursing homes in the country.

Keswick was recognized on Newsweek's 2023 and 2024 ranking of Best Nursing Homes in Maryland.

Keswick is an independently owned long-term care facility. With over 140 years of expertise, Keswick has become the area's premier provider of services for older adults. We are driven by our mission to improve the experience of aging, together.

Why Choose Keswick?

Keswick employees are part of a compassionate, and award-winning team, working together to deliver top care to the people of Baltimore. When you join our team, you can expect:

• Minimum rate of $18 for Full and Part Time GNA staff & $16 per hour campus wide
• Health and prescription coverage with lower-than-average deductibles and copays
• Dental and vision benefits (optional supplemental life insurance)
• Free short- and long-term disability coverage
• 401(k) program with employer matching up to 6%
• Generous vacation, sick, and holiday pay with an option to "cash out" unused vacation hours
• MTA discounted bus passes
• Teledoc - Free 24-hour access to a physician
• Employee Assistance Program with a variety of free services
• Employee Recognition Program
• Free access to our Employee Wellness Program, such as Zumba and Pilates

As a Clinical Reimbursement Manager, you will carry out our mission to improve the experience of aging together by being primarily responsible for the of the Clinical Reimbursement Department and clinical recording in the MDS and related documents for the skilled nursing facility. This position is responsible for planning, organizing, and directing the overall operation of the department in accordance with current federal, state, and local standards, guidelines, and regulations governing skilled and long-term care.

What will I do as a Clinical Reimbursement Manager?

• Oversees clinical reimbursement operations and ensures the collection of information (initial and ongoing) for the Minimum Data Set (MDS). Ensures the MDS coordinator team works with the nursing department for a comprehensive nursing assessment of the resident/patient health status.
• Demonstrates expertise in the completion of the MDS to capture services provided and facilitate optimal reimbursement. Ensures the appropriate MDS is completed timely for the various circumstances related to admission and quarterly assessments, interrupted stay, change of condition, etc.
• Works to identify coding that reflects the full patient condition and captures all appropriate ancillary and rehab conditions.
• Assures that documentation meets requirements of Keswick and regulatory agencies and is sufficient to support MDS coding as well as to substantiate reimbursement for Keswick services.
• Facilitates/assures process for managed care authorizations post admission, reviews contracts for compliance and seeks carve-outs and appropriate levels of authorized care.
• Oversees or directly participates in the triple check process with administration, rehab, and business office staff to ensure accuracy and regulatory requirements are met prior to billing.
• Meets with the rehabilitation director and personnel regularly to ensure documentation compliance and accuracy.
• Facilitates Utilization Review meetings or assigns designee.
• Identifies recurring problems and communicates to appropriate staff for resolution.
• Provides support to state and/or federal surveys, as needed.
• Oversee the tracking system of MDS schedules (timeframes and due dates)
• Seeks knowledge/clarification related to reimbursement regulation and MDS completion.
• Takes initiative to analyze the CASPER for potential areas of opportunity to improve clinical outcome measures for the Five Star Report and other clinical indicators. Works with the interdisciplinary team to develop action plans for improved capture of MDS documentation.
• Works to implement strategies to optimize Keswick's CMI as a reflection of documented services provided.
• Communicates and consults with other health team members.
• Prepares quality assurance reports and interprets/analyzes data for quality assurance purposes.
• Ensures timeliness of compliance with external audits; i.e., Telligen, pre/post payment reviews.
• Ensures timely completions of 3871s, Continued Stay Reviews, etc.
• Participates as an organizational leader and manager on-duty weekend rotation. Supports Keswick's overall mission, vision, and values.

What is required in this position?

• Registered nurse, licensed and in good standing with the Maryland Board of Nursing required.
• Resident Assessment Coordinator Certified (RAC-CT) certification desirable.
• KNOWLEDGE OF: Resident Assessment Instrument (RAI) manual, nursing and rehabilitation practice and principles; applicable laws and regulations governing long-term care and/or sub-acute (short stay) care; reimbursement requirements; diseases, conditions and treatment therapies for the patient population; MDS coding and regulations; ICD-10 Coding; Rehabilitation coding; patients' rights and the nursing role in helping protect and enhance those rights; principles and requirements for documentation and medical record management; computerized healthcare systems and medical records systems.
• SKILL IN: Using MDS computer program; PointClickCare (PCC) and Microsoft Office software and other software; communicating with other care providers, and administrative officials; effective listening and critical observations and utilizing the information for effective problem solving; relating to and working with the elderly, ill, disabled, recovering, emotionally upset and at times hostile people with tact and sensitivity.

What makes Keswick unique?

Our vision is for greater fulfillment and freedom of choice in aging, for all. Committed to enhancing the quality of life for the guests and residents it serves, Keswick provides various award-winning services that enhance their lives and get them back to doing what they love.

Keswick is an Equal Opportunity Employer.