The Clinical Reimbursement Specialist/Educator is responsible for education and oversight of the Resident Assessment Instrument (RAI) process in communities as assigned. This position supports the development of programs, education and business management systems that promote accuracy of the RAI, improved quality measures & patient care. As a result, the position will ensure accurate reimbursement for services provided. The position is responsible for providing training and oversight to clinical teams and administrators on CMS requirements, documentation and billing requirements. The Reimbursement Specialist performs regular complex reviews of clinically coded data in compliance with Official Coding guidelines in ICD 10-CM coding conventions. Using established auditing and research techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. As the Educator, they will provide leadership and training to the Interdisciplinary Team Members and staff. This will include promoting and educating on regulatory requirement and Sunrise programs as well as the coordination with vendors for outside education.
Sunrise maintains a drug-free work environment and all offers of employment with Sunrise are conditioned on submitting to and successfully completing and passing a drug and alcohol test.