Regional Reimbursement Manager
2 months ago
At SLP, our commitment is to provide love, attention and optimal care one resident at a time. We realize consistently fulfilling this commitment depends on the success of HR professionals like you, who build their careers with us. Together, we're setting the standard in the delivery of rehabilitation, quality post-acute services and long-term care.
Your talent will make a difference every day and we will make it count for you
Career Advantages We Offer:
• Medical, vision and dental insurance
• Employer-paid life insurance
• Paid time off
• Paid holidays
• Flexible schedule
• Long term growth and advancement opportunities
• And more....
Job Summary:
Under the supervision of the Vice President of Operations (VPO), and the Vice President of Clinical Reimbursement, the Regional Reimbursement Manager is responsible for training and management of the Clinical Case Manager in a manner that supports SLP Operations, LLC's philosophy, and policies, maintaining RAI/MDS compliance with federal and state regulations, Medicare reimbursement and state-specific regulations for Medicaid Case Mix.
Responsibilities:
- Conduct interviews for hiring new Clinical Case Managers (CCM) and assume responsibility for orientation and coaching CCMs to the clinical software program, RAI/MDS manual requirements, and state LTCMI processes with continued monitoring and oversight to ensure proficiency.
- Assume responsibility for the proactive oversight of OBRA and PPS assessment scheduling, setting of ARDs, MDS and LTCMI completion and transmission.
- Assume accountability for training and implementation of organizational policies, systems and procedures related to CCM-designated tasks
- Generate report of facility on-site visits, reviews, training and audits, and maintain open communication notifying Vice President of Operations (VPO), the VP of Clinical Reimbursement, and other regional team members of concerns, requests and investigation results.
- Oversee documentation to ensure compliance with Medicare program and Medicaid Case Mix guidelines
- Conduct in-service programs on ADL documentation, Restorative documentation, POC documentation and other MDS/PPS-related topics to facility staff as needed Monitor and evaluate CCM proficiency to provide on-going focused training and development.
- Monitor and evaluate daily, weekly and monthly Medicaid and Medicare meeting processes on a routine basis and conduct reviews/audits of Medicare process systems, procedures and documentation and of Medicaid Case Mix systems, procedures and documentation.
- Evaluate processes, systems and actions that impact Medicaid and Medicare compliance and make appropriate recommendations, with follow up to monitor implementation.
- Provide Medicare and Medicaid pre-admission consultation to facilitate development of census by providing reimbursement estimate and assessment of medical necessity to provide administrative team with knowledge for making an informed decision for smooth resident admissions.
- Organize monthly CCM reporting procedures to accomplish analysis for identifying trends or patterns that provide opportunities for improvement, including but not limited to: review, analyze and trend Quality reports, monthly Quality Measures report from CMS, MDS/PPS trackers and schedules, MDS transmission/validation reports, mock survey reports, compliance audit reports, OIG UR reports, State survey deficiency reports, Medicare monthly billing reports, MESAV reports and Additional Desk Review reports.
- Partner with therapy to promote effective interdisciplinary communication for team-based approaches to the resident assessment processes.
- Partner with Regional Nurse Managers to promote facility standards of quality resident care and documentation as related to the resident assessments.
- Provide monitoring of the Medicaid and Medicare budgeted rates and coaching for capturing appropriate RUG.
- Completes quarterly scorecard and development and implementation of action plans in response to findings, related to Medicare and Medicaid compliance.
- Evaluate CCM turnover to make appropriate recommendations to the regional team for execution of retention plans.
- Conduct facility onsite visits at a minimum of twice a month, or at the request of the VPO and/or supervisor.
- Analyze resident reviews/audits to ensure appropriate case management and capturing of appropriate resources on the MDS assessment.
- Provide consultation, guidance, and oversight of ADR requests, CCM audit requests, and CERT requests for appropriate and timely responses.
- Provide consultation, guidance and oversight of UR review visits and management of reconsideration requests.
- Any other Duties as assigned.
Requirements
- Licensed Vocational Nurse (LVN)/Registered Nurse (RN) in good standing and currently licensed by the State.
- Experience in long-term healthcare preferred.
- Possess knowledge of Resident assessment process with proficiency in analyzing MDS/RUG IV and RUG III Case Mix reports and trends.
- Experience in Medicare and Medicaid eligibility, billing, processes, and systems.
- Basic Computer Skills.
- Demonstrate strong clinical decision-making, critical thinking, and problem-solving skills.
- Must be capable of maintaining regular attendance in a high-demand, fast-paced work environment with project/work deadlines.
- Must be capable of performing the essential functions of this job, with or without reasonable accommodation.
- Must demonstrate effective communication skills with team members, and leadership skills regarding projects, goals, objectives, and successes both verbally and written.
We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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