Regional Director of Clinical Reimbursement

A Regional Skilled Nursing Facilities management team is currently seeking a Regional Director of Clinical Reimbursement.  This executive level position is responsible for the overall regulatory compliance of the MDS case management departments in five long term care facilities.

Responsibilities:

• Monitors that facilities follow Medicare/Medicaid regulatory and YAD Healthcare guidelines.
• Remains abreast of regulatory change for Medicare/Medicaid reimbursement and communicates necessary information to appropriate personnel.
• Collaborates with the facility to keep them informed of new developments for Federal and State payment systems.
• Reviews MDS documentation for accuracy and appropriateness
• Monitors and assists with validation of Quality Measures report for accuracy of MDS coding.
• Monitors and assists with validation of QRP Measures report for accuracy of MDS coding.
• Assists with developing and presenting training materials for MDS training sessions.
• Participates in interviews of facility MDS Coordinators.
• Performs audits per company standards and policies to ensure appropriate levels of reimbursement, and compliance.
• Assist team in review of clinical documentation prior to submitting to claim, and appeal source.
• Collaborates with corporate and/or facility staff related to denial issues affected by the MDS.
• Makes recommendations regarding eligibility and coverage for Medicare Part A.
• Tracks CMI reporting to ensure accurate capture of clinical complexities.
• Attends weekly Utilization review to promote appropriate clinical skilled coverage decision, progress/barriers toward discharge goals, and anticipated length of stay.

Experience:  

• Candidates with demonstrated experience in regional long term care management preferred.
• Leadership in directing and implementing change.
• Experience in providing staff training and consultation.
• Expertise in Minimum Data Set (MDS)/Care Planning and proficiency in Resident Assessment Instrument (RAI) process.
• Expertise in Federal, State reimbursement programs, such as: Medicaid; Medicare/Reimbursement Utilization Groups (RUGS) IV; private insurance; Veteran's Administration (VA) programs; bordering state contracts; et. al. B. Education and Training: (Acquired through formal education, outside study, training on jobs of lesser degree, or by any combination of these. May be expressed in terms of formal educational equivalents)

 Benefits:

• New competitive wages
• AMAZING comprehensive benefits package
• 401K
• PTO
• New added bonuses and perks
• Employee discounts

Job requirements:

Preferably a Registered Nurse with demonstrated Medicare and Medicaid knowledge. Possess strong leadership, communication and problem-solving skills. Must be willing to travel frequently.

RN (LPN) Licensed in VA.