Clinical MDS Account Manager
New
L
LimitlessliHealthcare
United States, Philippines Time (Monday to Friday, 8am to 6pm)Full-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- Minimum of 2+ years of experience in case management, utilization review, or related nursing role.
- Required Skills
- Microsoft Office Suite
Requirements
- Current Licensed Practical Nurse (LPN) in good standing with state-specific license.
- Minimum of 2+ years of experience in case management, utilization review, or related nursing role.
- Hands-on experience with MDS assessments and knowledge of CMS guidelines.
- Knowledge and prior experience in managed care processes and insurance authorizations.
- Familiarity with triple check process for billing and reimbursement.
- Proficient in electronic medical records (EMR) systems and Microsoft Office Suite.
- Reliable computer, noise-cancelling headset, and second monitor.
- Stable internet connection with a backup internet connection.
- Ability to work independently and collaboratively in a fast-paced environment.
Responsibilities
- Hold client relationship, communication and reporting for assigned clients alongside the SVP of Clinical Reimbursement.
- Coordinate and oversee patient care plans in collaboration with physicians, therapists, and nursing staff.
- Manage MDS assessments to ensure timely and accurate submission in accordance with federal and state regulations.
- Review, monitor, and manage managed care authorizations, ensuring patients receive appropriate and approved services.
- Participate in triple check processes to ensure accuracy of billing, coding, and clinical documentation.
- Communicate regularly with insurance providers, patients, and families regarding care plans and coverage.
- Monitor patient progress, outcomes, and transitions of care.
- Serve as a resource for staff education and training related to managed care, MDS, and documentation standards.
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