Per Diem, Clinical Reimbursement Manager (2/4 Weekends)

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) and plans visits 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 profit and loss 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 order of the diagnoses. The Clinical Reimbursement Manager oversees the progress of the client during the home health admission 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's) 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. On an annual basis this individual directly influences revenue of over 2 million dollars.

Education: Graduate of an accredited School of Nursing Associate's degree required. Bachelor's degree preferred

Licensures & Certifications: Current licensure in the Commonwealth of Pennsylvania as a Registered Nurse Valid driver's license and insured automobileHome Care Coding Specialist Certification as described above

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