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Director of Clinical Reimbursement

3 months ago

WESTERVILLE, United States Laurel Health Care Company Full time

The Director of Clinical Reimbursement will organize, direct, and provide training in the RAI Process and clinical documentation. This position is responsible for staying current on state-specific quality incentives and reimbursement related to clinical documentation. This role provides strategic direction and analysis to the clinical teams for quality improvement. Provides education, guidance, and development of CRSs (Clinical Resource Specialist). Use of various supporting software applications. Collaborates with corporate, regional, and facility interdisciplinary teams.  This role will travel to our skilled nursing facilities in Ohio, Indiana, Virginia, and North Carolina.

Join us with an attractive benefits offering:

  • Competitive pay
  • Medical, dental, and vision insurance
  • 401K with matching funds
  • Life Insurance
  • Employee discounts
  • Tuition Reimbursement
  • Student Loan Reimbursement

Responsibilities:

  • Assist with development of systems/processes in collaboration with VPCO and VPO to ensure regional and facility staff can perform efficiently
  • Provides information and education on the importance and use of the RAI/PPS/VA processes and their correlation to resident care and reimbursement. 
  • Provides instruction on how to read, interpret and use the information contained in various state and company generated reports, such as State Missing Assessment Report, Quality Indicators/Quality Measures, State Validation, Simple LTC Reports, etc.
  • Based on information derived from audits and other available data, the Director provides expertise, consultation, and guidance to appropriate employees to ensure MDS (Minimum Data Set) accuracy and adherence to company policy and procedures as well as state and federal regulations and guidelines. 
  • Through analysis of financial and clinical reports, identifies trends and areas of improvement and ensures an appropriate action plan is completed monthly.
  • Maintains in-depth knowledge of the clinical billing system and the MDS process to help investigate/troubleshoot user-related software issues.
  • Oversees and coordinates the process for a thorough and timely orientation for new MDS Coordinators.
  • Ensures current, new, and revised RAI/PPS information is distributed to appropriate employees promptly.
  • Participates in the Quality Review process.
  • Schedules announced and unannounced visits to the facilities.
  • Serves as a member of the CQAMC meeting as required.
  • Serves as a member of the policy and procedure committee.
  • Oversees the restorative program policies and procedures
  • Assist to identify changes necessary regarding current policies and procedures and established facility policies and procedures and communicates recommendations to the VPCO.

Requirements:

  • Active RN (Registered Nurse) license in state of residence or state(s) of practice, bachelor’s degree in nursing (BSN) is preferred.
  • NAC Certification
  • Must have, as a minimum, 5+ years’ experience with RAI process and PPS at the regional level or above and regulations knowledge.
  • Multi-facility experience preferred with Ohio, NC, VA and IN state specific experience.
  • Demonstrate and understand value-based payment and case mix reimbursement methodology.
  • Ability to travel up to 50%

Ciena Healthcare

We are a national organization of skilled nursing, subacute, rehabilitative, and assisted living providers dedicated to achieving the highest standards of care in five states including Michigan, Ohio, Virginia, North Carolina, and Indiana.

We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. Join us, if you have a passion for improving the lives of those around you and working with others who feel the same way.

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