Area Director of Clinical Reimbursement

Found in: Resume Library US A2 - 2 weeks ago

Tupelo Mississippi, United States Diversicare of Tupelo, LLC Full time
Overview:
Diversicare is a premier provider of post-acute care services to patients and residents at 43 skilled nursing and long-term care centers in five states. Together, with our team of dedicated healthcare professionals, we leverage our diverse strengths to provide each patient and resident with healthcare serves that best meet their needs.

It is Diversicare’s Mission to “Improve every life we touch by providing exceptional healthcare and exceeding expectations.”

Diversicare has an exciting opportunity for an Area Director of Clinical Reimbursement. In this role you will provide guidance and consultation of all aspects of the RAI process to assist facilities in meeting regulatory compliance. Additionally provide subject matter consultation on Medicare, Medicaid and Managed Care reimbursement and regulatory guidelines.

Responsibilities:
The key role of the Director of Clinical Reimbursement is to ensure that the RAI process at each facility is being completed/coordinated in a timely and accurate manner that is in compliance with federal and state regulations. In addition to these responsibilities, the following expectations, which are not all-inclusive, will guide the Area DCR:

Train and consult with RNACs and LNACs on the RAI, Medicare, Medicaid and Managed Care processes to facilitate compliance, integrity and accurate reimbursement.

Train and consult with center staff and administration on the RAI, Medicare, Medicaid and Managed Care processes to facilitate compliance, integrity and accurate reimbursement.

Function as the subject matter expert for the regional team on the RAI, Medicare, Medicaid and Managed Care processes

Utilize Electronic Health Record and other available data systems to audit and monitor integrity of:

PDPM HIPPS modifier trends

RUG Trends in case mix states

ALOS

ADL Coding Accuracy

Overall RAI process

Identification and resolution of data integrity issues

Medicare, Medicaid and Managed Care program requirements

Medicare, Managed Care and Medicaid rates

Utilize Electronic Health Record and other available data systems to analyze and project Medicare, Managed Care, and Medicaid rates to facilitate accurate identification of provided services.

Review and analyze QM reports, investigate trends, and assist facilities in development and completion of plans to influence improvement.

Train and consult with centers on Medicare, Medicaid and Managed care Documentation Requests to ensure prompt response and corrective action.

Support Centers in retention and recruitment of MDS staff:

Complete second level interviews

Orient and provide ongoing training

Provide recommendations for performance assessment to administrator

Participate in Regional meetings and activities:

Quality Reviews

QAPI

Participate in Clinical Reimbursement Department Activities:

Program Development

Trainings

In the absence of a center NAC, Area DCR will provide direct center support which may include completion of tasks assigned to the NAC. This support may be onsite or remotely depending upon the need.

Other duties as assigned by leadership.

Qualifications:
1. Current RN license by State Board of Nursing.
2. Minimum of 3 years’ experience as an MDSC.
3. Prior experience in multi-facility consultation.
4. Excellent communication skills; prior experience in teaching/training preferred.
5. Computer skills necessary.
6. Must obtain AANAC RAC-CT certification within 1 year of acceptance of position or Relias CMAC certification.

  • Area Director of Clinical Reimbursement

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