Reimbursement Services Director directs and supervises the activities of the claims and provider reimbursement personnel. Handles third-party reimbursement for services rendered to patients. Being a Reimbursement Services Director sets procedures for filing reimbursement claims and ensures timely and accurate claims payments. Monitors, evaluates and reviews all cost reporting in support of reimbursement claims. Additionally, Reimbursement Services Director develops policies and procedures compliant with fiscal and regulatory requirements. Oversees the collection of statistical and financial data needed for preparing annual and monthly health insurance reports. May require an advanced degree. Typically reports to top management. The Reimbursement Services Director 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 typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
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.
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:
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.