Clinical Reimbursement Director
1 month ago
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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