Director of Clinical Reimbursement
2 weeks ago
Ebenezer is looking for a Director of Clinical Reimbursement to join our team This nursing role is responsible for coordination and overseeing the areas of RAI process and reimbursement process for long-term care. Schedule is full-time, mainly day shifts, salaried.
Martin Luther Care Center , part of the Martin Luther Senior Living Campus, is located in East Bloomington, MN near woodlands/wetlands and along the Minnesota River Bluffs. Managed by Ebenezer, we offer 137 units between our Skilled Nursing, Memory Care, and Transitional Care. We have an outstanding team of tenured staff. The only thing missing is YOU Martin Luther Care Center was named Top Nursing Home and Transitional Care Center by US News and World Reports the past two years.
Amazing Benefits
- Paid Time Off, Retirement monies, tuition reimbursement, scholarships, Medical/Dental/Vision, Wellness stipend, Cash Out Wages Before Payday with our New Benefit of Early Wage Access
Ebenezer is proud to be voted 2024 Star Tribune Top Work Place , and has received this honor fifteen years in a row. We're an established organization with over 100 years of excellent service and an outstanding rate of growth. When you come to work at an Ebenezer community, we strive to support your growth, honor your strengths and empower you to make a difference in the lives of others.
Responsibilities/Job DescriptionDevelops and/or assures accuracy of care plan process. Oversees coordination of all required Resident Assessment Instruments per state and federal regulations to ensure timely completion. Monitoring of input into the MDS (Minimum Data Set)/RAI process to ensure accuracy. Acting as a resource to all team members when questions arise on how to answer questions on the MDS. Mentoring, re-educating, and training of RAI sections to team members as appropriate to increase competency in their designated roles. Completes nursing sections of MDS, CAA. Distributes updates and schedules for MDS completion to IDT and ensures timely completion. Notifies Department Managers and/or Administrator of significant issues or persistent problem areas that have an impact on star rating, Quality indicators, and reimbursement at a minimum. Updates resident diagnosis as applicable. Actively involved at the IDT meetings. Follows CMS/RAI for corrections as instructed. Backs-up and assists Medical Records Coordinator for ICD-10 coding.
Assures timely transmissions of all required MDS’s per state and federal regulations. Manages follow-up of all transmission error issues in a timely manner and in compliance with CMS regulations. Maintains timely communication with the accounts receivable department regarding completion of RAI process as it relates to billing. Collaboration with AR and clinical departments on the process and compliance with related state and federal regulations. Completes audits to assure accuracy of PDPM payment level. Monitors PDPM payment levels. Reviews Validation reports and makes appropriate corrections with IDT members when appropriate. Informs IDT members of validation errors as appropriate. Understands PDPM payment level to ensure maximum payment. Participates and plays an active role in Triple check.
Attends outside seminars and webinars, focusing on current MDS changes and regulations. Attends ongoing educational offerings of topics pertaining to assigned duties to remain current in areas of responsibilities. Attends mandatory in-services. Subscribes to trade magazines and websites to stay up to date with changes. Assists with incorporating new learning into practice by revising policies and procedures. Communicates new information to IDT.
Assists IDT in determining MDS accuracy issues related to Quality Indicators. With appropriate IDT members, develops and implements appropriate Action Plans to correct MDS accuracy issues. Participates in Quality Assurance Committee meetings as directed by Administration.
Provides educational training related to MDS/RAI process to all staff on an ongoing basis and as needed. Participates in management meetings as assigned. Participates in Nurse on-call weekend rotation per facility protocol. Meets with Administrator and Director of Nursing as directed.
QualificationsRequired
- Associate Degree – Registered Nurse (required within 90 days after hire date)
- RN Licensure/Registered with the MN Board of Nursing (may initially hold LPN licensure but RN licensure required within 90 days after hire date)
- Current Basic Life Support (BLS) for Health Care Provider from American Heart Association (AHA) or American Red Cross; accepted certifications as follows:
- AHA: BLS for Healthcare Providers (CPR & AED) Program or BLS Provider - BLS Instructor.
- American Red Cross: CPR/AED for Professional Rescuers and/or Healthcare Providers, Lifeguarding First Aid/CPR/AED.
Preferred
- One to Three years previous experience
- ANACC Certification
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