Clinical Reimbursement Director

1 day ago


Lafayette, Colorado, United States Frontline Management Full time
Job Description

Frontline Management is seeking an experienced Director of Clinical Reimbursement to join our team in a dynamic and supportive environment.

The ideal candidate will have a strong background in clinical reimbursement and a passion for delivering high-quality care to our residents.

We offer a competitive salary and a comprehensive benefits package, including medical, dental, and vision insurance, as well as a 401(k) plan.

Key Responsibilities:

  • Provide education and training to facilities on the Resident Assessment Instrument (RAI) process.
  • Review and coordinate PPS and case mix data for the division to ensure appropriate utilization of available resources.
  • Establish and evaluate MDS and PPS systems for accuracy and timeliness.
  • Prepare clinical teams on MDS process.
  • Partner with facilities on MDS issues and concerns during survey process.
  • Validate HIPAA coding.
  • Review transmission and RUGs reports, analyzing for accuracy and timeliness of MOS transmission.
  • Ensure successful billing by utilizing triple check.
  • Coordinate training to new MDS Coordinators on the MOS, RAI, and transmission process.
  • Provide education and training on RUGs and resource management of Medicare residents.
  • Educate facilities on effective systems of coding, inputting, and transmitting MOS data to ensure accuracy of MOS and ensure quality of care our residents receive.
  • Improve survey history relating to RAI process.
  • Ensure residents receive appropriate level of care and reimbursement reflects level of service provided.
  • Work with state and federal RAI coordinators to identify specific requirements of state process.
  • Provide education to needed/required associates of regulation updates and changes.
  • Keep abreast of changing regulations.

Requirements:

  • Nursing degree (LPN or RN) from accredited college – RN preferred.
  • Active nursing license.
  • One year or more working with RAI process and PPS.


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