Reimbursement Services Director - Home Care directs and supervises the activities of the benefits claims and provider reimbursement personnel in a home care environment. Sets procedures for filing reimbursement claims and ensures timely and accurate claims payments. Being a Reimbursement Services Director - Home Care monitors, evaluates and reviews all cost reporting in support of reimbursement claims. Produces the documentation necessary for reimbursement, Medicare Compliance, and control of receivables. Additionally, Reimbursement Services Director - Home Care may require an advanced degree. Typically reports to top management. The Reimbursement Services Director - Home Care typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Reimbursement Services Director - Home Care typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
Competitive pay ($28.00-$34.00 an hour)Benefits:
Reports to: President/Owner
Job Summary
The primary goal of the Director of Care is to ensure clients receive the highest quality care in accordance with Company standards. Within the framework of the objectives and policies established by the Company, plans and coordinates care objectives that promote quality within the Company both within and outside the Company. Participates as member of the company’s management team in planning, policy formulation and administrative decision making with a particular reference to the role, functions and operations of the agency’s services.
Essential Functions
1. Maintains compliance to all Agency clinical and administrative policies, procedures and regulatory requirements.
2. Evaluate and supervise all staffing activities of Staffing Coordinator(s) and Caregivers, HHA's, CNA's including:
a. Assist in the recruiting, hiring, training, and on-going supervision of Staffing Coordinator(s and Caregivers, HHA's, CNA's.)
b. Review Daily Priority Sheets at 4pm daily
c. Ensure all shifts are covered, and contingency plans are in place
3. Evaluate and supervise all Agency homecare field staff for conformity with professional standards of home health care, and in accordance with state health statues and home care licensure requirements.
4. Ensures the quality of patient care and service by using specialized knowledge and judgment to assure patient care standards are in compliance with applicable State Practice acts and Agency policies and appropriately maintains the client record in both client home and office settings.
5. Performs or supervises case management activities for individual patients, including but not limited to assessments, teaching and development, and updating of the care plan or paraprofessional tasks sheet.
6. Manage inquiry calls in cooperation with Inside sales team using the following standards:
a. Answer telephone using professional etiquette.
b. Follow the prescribed inside sales process including being responsive, building a strong relationship with the caller, qualifying the client, developing the care profile, gaining
commitment, and following up on leads.
c. Communicate features, benefits and advantages that relate to the identified needs of each potential client.
d. Maintain a minimum 40% conversion ratio converting inquiries into consultations.
e. Answer all service-related questions from the caller.
f. Communicate effectively and persuasively to all callers.
g. Document all service inquiry activity according to standards.
h. Enter service inquiry data into designated software system according to standards.
i. Schedule consultations for potential clients and designated office personnel in timely manner.
j. Make follow-up contact via phone calls, letters, and emails to referral sources inquiring about potential clients, as appropriate.
k. Make follow-up contact via phone calls, letters, and emails on RAH client referrals made to other providers such as facilities, elder attorneys, etc.
l. Contact physicians of new clients with summary of services provided as appropriate.
m. Follow up on non-converted clients by adhering to established follow-up procedures.
7. Coordinates with Director of Nursing for arrangements with other healthcare and equipment providers to assure continuity of care and adherence to the patient plan of care.
8. Provides for in-service education for Personal Care Assistants, Homemakers and Professional Staff Personnel.
9. Helps improve the knowledge base and effectiveness of agency staff by teaching inside sales initiatives and further program development.
10. Actively engages in training and new hire orientation in order to demonstrate professional home care standards.
11. Reviews client/caregiver notes to ensure compliance and quality in documentation and care.
12. Manages company client survey programs by promoting participation, reviewing results, and making recommendations to the management team on improving the quality of care.
13. Promotes a positive image of the Agency within the office and in the community by communicating, in words and actions, our Mission and Values to all stakeholders (clients and their families, caregivers and their families, referral resources, colleagues, community partners, etc).
14. Promotes Agency to the community, participating in community programs with other professionals when necessary and forming alliances that are most beneficial to the agency.
15. Documentation of care / issues/ events in ClearCare and in client / caregiver files as directed by state licensure guidelines and RAH recommendations.
16. Communicates all Agency complaints, both staff and client, to Executive Director/Owner and follows up as required.
17. Performs on-call coordinator duties as needed.
18. May be required to travel on company business.
Additional (non-essential) Functions
1. Represent Agency before public as required by President/Owner.
2. Other duties assigned by President/Owner.
Education, Experience, Knowledge, Skills, Abilities and Availability
1. One year of supervisory experience required.
2. Home care experience required.
3. Read, write speak and understand English as needed for completion of job.
4. Have a valid driver’s license and use of an insured automobile or access to adequate transportation. 5. Inside sales experience using consultative techniques preferred.
6. Computer experience with data entry, word processing and Microsoft Windows® based software. 7. Current Register Nurse or Social Work license strongly preferred.
Working Environments
1. Works both in office and in patients’ homes as required for supervisory and assessment visits.
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