Director, Clinical Reimbursement

4 weeks ago

Brentwood, United States Brookdale Senior Living Full time

Director, Clinical Reimbursement

Overview

Brookdale seeks experienced Director of Clinical Reimbursement to support our SNF Portfolio.

This opportunity is based out of our Brentwood, TN corporate office.

Voted by Newsweek in 2024 as one of America's Greatest Workplaces for Diversity

Make Lives Better Including Your Own.

If you want to work in an environment where you can become your best possible self, join us You'll earn more than a paycheck; you can find opportunities to grow your career through professional development, as well as ongoing programs catered to your overall health and wellness.

Full suite of health insurance, life insurance and retirement plans are available and vary by employment status. Additional benefits offered include, but are not limited to:

* Tuition Reimbursement
* Pet Insurance
* Adoption Reimbursement Benefits
* Variety of Associate Discounts

This is an incentive based position, which may include bonuses, incentive or commission plans.

Veterans, transitioning active duty military personnel, and military spouses are encouraged to apply.

To support our associates in their journey to become a U.S. citizen, Brookdale offers to advance fees for naturalization (Form N-400) application costs, up to $725, less applicable taxes and withholding, for qualified associates who have been with us for at least a year.

Responsibilities

The Director of Clinical Reimbursement is responsible for the oversight of Medicare/Medicaid/Managed Care reimbursement and regulatory issues. This will role will provide managerial support to our skilled nursing communities.

* Ensures that reimbursement structures are managed, evaluated, and capture accurate resource utilization at the facility level.
* Responsible for the tracking, auditing, and analyzing of data for reimbursement and support of the coding of the MDS.
* Promotes the capturing of appropriate clinical reimbursement for services provided while ensuring the highest level of revenue integrity.
* Understands regulations, practice standards, and procedures, as well as laws and guidelines pertaining to the RAI process and payment methodologies for all payers, including, but not limited to CMS and PDPM.
* Oversees reporting systems to audit facility MDSs and determine modifications needed as appropriate, as well as providing education to the facility on the reasons for the necessary modification.
* Trains and educates the facility team as it relates to current state and federal regulations for reimbursement and payment models for both PDPM and state specific Medicaid models and CMI.
* Analyzes and reports the impact of federal and state Medicare/Medicaid regulatory changes and develop responses, as needed.
* Conducts facility visits to support the teams in each facility, while providing a visit report to the regional team, operations, rehab, and the VP, Clinical Operations and Regulatory Compliance.
* Partners with Operations, clinical and financial team members to develop and enhance clinical reimbursement tools and systems.
* Completes monthly review/reporting of CASPER reports to audit RAI process and review QMs, as well as a monthly action plan for QMs related to 5-star rating system.
* Continues an ongoing communication and collaboration with the regional and corporate teams.

This job description represents an overview of the responsibilities for the above referenced position. It is not intended to represent a comprehensive list of responsibilities. An associate should perform all duties as assigned by his/her supervisor.

Qualifications

Education and Experience

Bachelor's Degree in Nursing with 8-10 years of healthcare related experience in care of the senior population required. Must have experience as Regional Director of Reimbursement and expert level knowledge of RAI process and MDS 3.0. Must have Minimum of 8 years of demonstrated leadership skills and competencies required.

Certifications, Licenses, and Other Special Requirements

Active RN License in good standing required. Certification as RAC-CT required.

Management/Decision Making

Applies existing guidelines and procedures to make varied decisions within a department. Uses sound judgment and experience to solve moderately complex problems based on precedent, example, reasonableness or a combination of these. Uses independent judgment to make decisions based on scope of nursing practice, safety, consideration for liability, and knowledge of the risk management processes.

Knowledge and Skills

Possesses extensive knowledge of a distinct skill or function and a thorough understanding of the organization and work environment. Has a working knowledge of a functional discipline. Extensive knowledge of the Resident Assessment Instrument (RAI) and MDS 3.0. Strong knowledge of case mix, therapy utilization, and restorative nursing.

Physical Demands and Working Conditions

* Standing
* Walking
* Sitting
* Use hands and fingers to handle or feel
* Reach with hands and arms
* Climb or balance
* Stoop, kneel, crouch, or crawl
* Talk or hear
* Ability to lift: up to 25 pounds
* Vision
* Requires interaction with co-workers, residents or vendors
* Occasional weekend, evening or night work if needed to ensure shift coverage
* On-Call on an as needed basis
* Requires Travel: Occasionally
* Requires Driving: Drives self (Tier 2)

Brookdale is an equal opportunity employer and a drug-free workplace.

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