Regional Reimbursement Manager

4 weeks ago

Abilene, Texas, United States SLP Operations, LLC Full time
Job Summary

At SLP Operations, LLC, we are committed to providing exceptional care and services to our residents. We are seeking a highly skilled Regional Reimbursement Manager to join our team. This role will be responsible for training and managing Clinical Case Managers, ensuring compliance with federal and state regulations, and promoting effective interdisciplinary communication.

Key Responsibilities
  • Conduct interviews and train Clinical Case Managers on clinical software programs, RAI/MDS manual requirements, and state LTCMI processes.
  • Oversee the proactive management 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 reports of facility on-site visits, reviews, training, and audits, and maintain open communication with the Vice President of Operations and other regional team members.
  • 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 ongoing 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.
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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