Regional Director of Clinical Reimbursement
4 weeks ago
A Regional Skilled Nursing Facilities management team is currently seeking a Regional Director of Clinical Reimbursement. This executive level position is responsible for the overall regulatory compliance of the MDS case management departments in five long term care facilities.
Responsibilities:
Monitors that facilities follow Medicare/Medicaid regulatory and YAD Healthcare guidelines.
Remains abreast of regulatory change for Medicare/Medicaid reimbursement and communicates necessary information to appropriate personnel.
Collaborates with the facility to keep them informed of new developments for Federal and State payment systems.
Reviews MDS documentation for accuracy and appropriateness
Monitors and assists with validation of Quality Measures report for accuracy of MDS coding.
Monitors and assists with validation of QRP Measures report for accuracy of MDS coding.
Assists with developing and presenting training materials for MDS training sessions.
Participates in interviews of facility MDS Coordinators.
Performs audits per company standards and policies to ensure appropriate levels of reimbursement, and compliance.
Assist team in review of clinical documentation prior to submitting to claim, and appeal source.
Collaborates with corporate and/or facility staff related to denial issues affected by the MDS.
Makes recommendations regarding eligibility and coverage for Medicare Part A.
Tracks CMI reporting to ensure accurate capture of clinical complexities.
Attends weekly Utilization review to promote appropriate clinical skilled coverage decision, progress/barriers toward discharge goals, and anticipated length of stay.
Experience:
Candidates with demonstrated experience in regional long term care management preferred.
Leadership in directing and implementing change.
Experience in providing staff training and consultation.
Expertise in Minimum Data Set (MDS)/Care Planning and proficiency in Resident Assessment Instrument (RAI) process.
Expertise in Federal, State reimbursement programs, such as: Medicaid; Medicare/Reimbursement Utilization Groups (RUGS) IV; private insurance; Veteran's Administration (VA) programs; bordering state contracts; et. al. B. Education and Training: (Acquired through formal education, outside study, training on jobs of lesser degree, or by any combination of these. May be expressed in terms of formal educational equivalents)
Benefits:
New competitive wages
AMAZING comprehensive benefits package
401K
PTO
New added bonuses and perks
Employee discounts
Job requirements:
Preferably a Registered Nurse with demonstrated Medicare and Medicaid knowledge. Possess strong leadership, communication and problem-solving skills. Must be willing to travel frequently.
RN (LPN) Licensed in NC/SC
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