A Clinical Reimbursement Coordinator works in medical settings such as health care clinics, hospitals, and nursing homes. The main job role of this position is to ensure that healthcare providers receive the correct reimbursement for the services offered and for which they are covered under their insurance programs. To complete this core task, the following additional duties mentioned on the Clinical Reimbursement Coordinator Resume are carried out – examining patient’s records and medical care programs, communicating with managed care professionals regarding cost controls, overseeing the workplace to confirm they are properly abiding with standards for qualification. Performing administrative tasks are also a part of the job description.
The nature of the job demands the following skills and abilities – knowledge of special medical codes, the ability to determine the eligibility of certain types of coverages, strong communication skills to interact with various insurance carriers, and an extensive experience with MDS. To qualify for this job, one needs to possess a degree and have prior work experience in the field.
Summary : Clinical Reimbursement Coordinator with over 20 years of experience in nursing with a focus on management directly related to the needs and care of deserving individuals. Strong advocate for patients' rights. Outstanding assessment skills with great attention to detail and sound decision-making abilities.
Skills : AANAC MDS 3.0 Certified, Unit Manager, MDS 3.0 Certified, ADON, Management 20 Plus Years, MMQ, IV,Wounds.
Description :
Responsible for reviewing OASIS assessments, coding and sequencing diagnoses in accordance with medicare guidelines, instructing nurses regarding assessment strategies and medicare guidelines.
Served as a mentor for less experienced nurses and provided leadership in the field and the office.
Mastered ICD-9 coding and clinical reimbursement.
Provided administrative assistance, as needed, including scheduling follow-up appointments or providing clinical updates to payors, as needed Initiates efficiency initiatives for durable medical delivery process. (EF).
Provided front-line problem resolution to straightforward questions or customer service needs.
Provided guidance to payors/ancillary partners and/or CM Representatives on service standards and service recovery.
Partnered with leadership to implement best practices to deliver unparalleled service.
Experience
10+ Years
Level
Senior
Education
BSN In Nursing
Clinical Reimbursement Coordinator Resume
Headline : To obtain a management or corporate position in the Long Term Care/ Rehab/ Assisted Living field that will allow me to utilize my experience working with the elderly population and enhancing their quality of life by providing the highest quality care possible while maintaining compliance with state and federal guidelines.
Skills : Insurance Review, MDS, Computer Skills.
Description :
Worked for Glenwood Healthcare, Inc.
Assisted the Administrator in day to day functions of the facility.
Included scheduling of MDS's to maximize RUG utilization, conducting PPS meetings, working closely with the Therapy department to enable residents to attain highest level of function possible and month-end billing through the triple check process.
Worked with hospitals, physicians, and other skilled nursing facilities to evaluate patients for appropriate placement to the facility and discharge planning, as appropriate.
Tracked and trended service failures. Articulates and takes action for service gaps to leadership and along with recommendations for improvement.
Collaborated with the leadership team to develop strategies to maximize efficiency and remove barriers to ensure effectiveness of post-acute care referrals or minimize denials or delays.
Participated in action plans for transition of care/discharge questions for patient satisfaction.
Experience
5-7 Years
Level
Executive
Education
MS
Clinical Reimbursement Coordinator Resume
Headline : Clinical Reimbursement Coordinator with diverse work background, strong clinical skills, broad scope of knowledge, & the drive to excel seeking a full-time day shift nursing position that will provide opportunities for growth & development as a healthcare professional. Interested in positions within present scope of experience, as well as any opportunities to expand career by transitioning to new roles working with other populations &/or settings.
Skills : Communication And Leadership ; Wound Care Certified.
Description :
Directed interdisciplinary team in related processes for MDS 2.0 completion for assigned 39 beds (see description under Kindred).
Scheduled all required MDS assessments, facilitated electronic transmission & verification of assessments & reports to State, & managed communications with payor sources, submitting documentation as requested for authorizations & monitoring for eligibility or changes requiring case-mix adjustment.
Earned certification as Resident Assessment Coordinator.
Participated in the on-call rotation for facility staff coverage.
Resigned to accept new position after unable to resolve scheduling in violation of hiring agreement with administration.
Initiated, directed, maintained Medicare PPS/OBRA assessments and schedules.
Negotiated all rates, level of care on one time contracts for managed care patients.
Experience
5-7 Years
Level
Executive
Education
Associates In Science
Clinical Reimbursement Coordinator Resume
Headline : A highly experienced Clinical Reimbursement Coordinator professional with corporate and comprehensive skills in strategic planning and implementation in PPS, MDS, legal, Utilization review and Care Planning seeking a position where these skills will add value to a company adding my skills to reach the optimum success increasing patient care and reimbursement.
Skills : LPN License, Planning Skills.
Description :
Led assesment coordinator for Medicare and assist in manage care assessment.
Performed progress reviews on each resident.
Assisted with discharge planning, DME and special needs.
Ensured proper clinical reimbursement and management of care to balance the resident and companies needs.
Directed a department and with oversite in Managing and capturing the best clinical reimbusement for PPS, while maintaining the federal guidelines and producing the best clinical picture and reimbursement for the facility.
Provided, assessed and assisted in the medical needs of the patient.
Managed the overall process and tracking of all Medicare/Medicaid case-mix documents in order to maximize reimbursement for services provided within the Center.
Experience
5-7 Years
Level
Executive
Education
LPN In Nursing
Clinical Reimbursement Coordinator Resume
Summary : Collaborating with the leadership team to develop opportunities to improve documentation of insurance correspondence and compliance with payors/appeals, distribution of regulatory notices, including the CMS Important Message from Medicare, Medicare Outpatient Observation Notice, etc.
Skills : Panning Skills, Monitoring Skills.
Description :
Coordinated the day to day operations of market Clinical Education Service Line, including coordinating nursing student placement and schedules and facilitating communication with clinical education employees.
Sought and implemented strategies for operational improvement.
Supported clinical educators in scheduling classes, and ensures scheduled classes are properly set up with applicable education materials and equipment.
Supported the efforts of market and hospital personnel by providing prompt, accurate information necessary for the hospital to maintain accreditation standards of the Joint Commission, Medicare, Medicaid, and similar organizations.
Served as the HealthStream administrator for the market, including building e-learning classes, maintaining student groups, entering data, and providing reports as needed.
Provided timely, accurate, and professional support to the clinical education team.
Managed and distributed data reports referencing quality, education, and patient experience.
Experience
7-10 Years
Level
Management
Education
M.S. In Health Care Administration
Clinical Reimbursement Coordinator Resume
Headline : Five years of experience in direct patient care at Cone Health Hospital. Maintaining a strong reputation for achieving high levels of patient satisfaction, seeking leadership roles, and possessing excellent communication and teaching skills. Strong desire to focus on preventative care and health education.
Skills : Point Click Care Software, Communication Skills.
Description :
Provided staff training/in-service as related to patient care and needs.
Maintained accurate schedule for MDS completion to insure timely tranission to CMS as prescribed by regulations.
Conducted concurrent MDS reviews to assure the maximum allowable RUG categories, and monthly Medicare/Medicaid budget.
Identified opportunities to improve the customer experience.
Contributed towards improving department scores for patient satisfaction on unit-based scorecard through peer-to-peer accountability.
Served as a role model for situational awareness, using teachable moments to improve safety.
Participated in quality improvement initiatives and collects data for use in department performance improvement as directed.
Experience
5-7 Years
Level
Executive
Education
MS
Clinical Reimbursement Coordinator Resume
Objective : Effectively communicating with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles.
Skills : Coordinating Skills, Data Driven Skills.
Description :
Provided leadership on the Department of Public Health's (DPH) strategic plan for health equity and public health impact initiatives.
Focused both on addressing inequities within DPH as an organization and externally in addressing health inequities in the St. Louis County region by collaborating with partners, stakeholders, and the community.
Used a data driven and evidence- and practice-based approach, in alignment with the department's strategic priorities, to provide technical expertise, project management, and leadership related to the development, implementation, and oversight of the health equity and impact plans.
Assessed, evaluated, and continually reported on the department's progress toward health equity and impact goals.
Identified grant and contract funding opportunities to advance DPH strategic priorities.
Worked with DPH staff to align funding opportunities with program efforts and provide support in shaping grant applications with strategic priorities, goals, and activities of the department.
Identified emerging issues and support department staff in identifying strategic opportunities that would improve health outcomes and health equity.
Experience
2-5 Years
Level
Executive
Education
Bachelors
Clinical Reimbursement Coordinator Resume
Summary : Hardworking, organized, Clinical Reimbursement Coordinator professional with a proven background delivering sensible business technology solutions on time and under budget while working as a team member or team leader.
Skills : Clinical Skills, Training Skills.
Description :
Administered the overall process and tracking of all Medicare/Medicaid case-mix documents in order to maximize reimbursement for services provided within the Center.
Managed MDS staff to ensure that MDSs are completed in accordance with both Federal and State Regulations.
Served as Manager on Duty on weekends to oversee facility operations and resolve staff/family issues.
Participated in daily meetings with the Interdisciplinary Team to ensure that residents are provided with quality health care.
Conducted staff training to improve the accuracy of documentation to maximize reimbursement.
Completed of MDS assessments as prescribed by law and all necessary forms, care plans, etc to insure all resident wants and needs are being met.
Contributed to identification of corrective action and improvement activities to meet department and hospital targets for quality and safety, collaborating with the interprofessional health care team.
Experience
7-10 Years
Level
Management
Education
M.S. In Health Care Administration
Clinical Reimbursement Coordinator Resume
Summary : A position that will enable me to use my experience and knowledge as an MDS/Clinical Reimbursement Coordinator gained while working in Long Term Care. Position Description Completed all Medicare and Managed Care MDS assessments, focusing on Late Loss reviewed re-admission screens, and met with Rehab Program Director daily in order to establish appropriate ARD to insure highest RUG level for all Medicare residents.
Skills : Implementation Skills, Communication SKills.
Description :
Supported the efforts of market and hospital personnel by providing prompt, accurate information necessary for the hospital to maintain accreditation standards of the Joint Commission, Medicare, Medicaid, and similar organizations.
Served as the HealthStream administrator for the market, including building e-learning classes, maintaining student groups, entering data, and providing reports as needed.
Provided timely, accurate, and professional support to the clinical education team.
Managed and distributed data reports referencing quality, education, and patient experience.
Role modelled as a preceptor and implements staff education specific to patient populations and unit processes; coaches and mentors other staff.
Functioned a resource for case management and social work resources and needs for the department and the hospital.
Exemplified/led teamwork by responding positively to requests for assistance.
Experience
7-10 Years
Level
Management
Education
Diploma
Clinical Reimbursement Coordinator Resume
Headline : Streamlining concurrent insurance denials and/or appeals process, in collaboration with management and nursing staff, Developing and implements best practices to ensure timely and accurate EMR documentation of authorization, approvals, and denials and recommends strategies for improvement.
Skills : Developing Skills, Designing Skills.
Description :
Fostered staff engagement by demonstrating active listening, requesting and acknowledging feedback, making equitable decisions, providing rationale when appropriate, and supporting organizational. (EF)
Arranged, expedited and completed acquisition of post-acute care needs or secures insurance authorization, as directed, confirming with social workers and case managers, and ancillary departments, based on physician orders, payor/reimbursement practices and regulations that may impact the patient's plan of care. (EF)
Facilitated designing and redesigning of CM representative processes and workflow.
Actively participated in making recommendations for improving working relationships in the department, hospital, vendors, and post-acute providers.
Led contributions with leadership to identify workflow opportunities, assisting with recruitment and retention efforts, including to improve employee engagement department scores for CM representatives through peer-to-peer accountability.
Creating an account is free and takes five seconds.
You'll get access to the PDF version of this resume template.
Choose an option.
Sign up with Google
Sign up with Facebook
Sign up with Linkedin
This helps us make sure you're human and prevents spammers from abusing our services.
By continuing, you agree to our Privacy Policy and Terms.
Unlock the Power of Over 10,000 Resume Samples.
Take your job search to the next level with our extensive collection of 10,000+ resume samples. Find inspiration for your own resume and gain a competitive edge in your job search.
Get Hired Faster with Resume Assistant.
Make your resume shine with our Resume Assistant. You'll receive a real-time score as you edit, helping you to optimize your skills, experience, and achievements for the role you want.
Get Noticed with Resume Templates that Beat the ATS.
Get past the resume screeners with ease using our optimized templates. Our professional designs are tailored to beat the ATS and help you land your dream job.
