• Clinical Reimbursement Specialist / Educator

    Requisition Post Information* : Posted Date 2 months ago(2/12/2018 1:56 PM)
    Location : Name
    Job ID

    "Sunrise is the best place that I've ever worked, simply because of the people. We provide quality care in an environment that feels like home. Our focus is doing what’s right for the resident. For me, that’s a big breath of fresh air."

    - Sunrise Leader


    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.




    • Train and consult with RACs on the RAI, Medicare, Medicaid and Managed Care processes to facilitate compliance, integrity and accurate reimbursement.
    • Provides community interdisciplinary (IDT) teams with education and support for the development of systems to address and manage Quality Measures (QM) and the CMS Five Star Rating.
    • Function as the subject matter expert for the regional team on the RAI, Medicare, Medicaid and Managed Care processes.
    • Provides leadership, oversight and acts as a resource for community team members to the RAI process, the Medicare program, Medicaid programs, and Managed Care or Commercial Insurance programs.
    • Provides orientation, education and training to community team related to the RAI, Medicare, Medicaid and other reimbursement related topics as assigned. 
    • Works with interdisciplinary teams on educational opportunities to plan, assist and follow through on CMS guidelines as well as Sunrise programs and procedures.


    • RN with active license
    • At least 5 years of minimum data set (MDS) experience
    • At least 2 years of multi-site MDS experience
    • At least 2 years of auditing required
    • Bachelor’s Degree in health care related or business related field, or 5 years of recent, direct experience with third party payer requirements

    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.


    Sunrise Senior Living has championed quality of life in senior care for more than 30 years. We believe team members are our greatest resource and are looking for people who share our commitment to provide quality care for seniors and their families. It's no surprise that many of the world's leading experts in Senior Living entrust their career to Sunrise.
    At Sunrise, you will…

    Make a Difference Every Day
    We are passionate about our mission — to champion quality of life for all seniors. We deliver high-quality care with a personal touch and encourage our residents to enjoy life to the fullest.


    Be Part of a Uniquely Supportive Community
    The care-focused environment we create for residents extends to our team members. We offer programs, rewards, and benefits to help you live your best.


    Ignite Your Potential
    We believe potential has no limits. We offer best-in-class leadership development programs designed to grow our leaders. We are committed to helping our team members achieve their career goals.


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