Director Clinical Reimbursement
Director Clinical Reimbursement
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Salary Not Disclosed
1 Vacancy
Job Description
Overview
Smile Youve Found Us!
Are you passionate about caregiving Would you like to work with the best team in the world If so Diversicare invites you to apply.
We build on trust respect customer focus compassion diplomacy appreciation and strong communication skills to shape the culture in our workplace. Diversicare team members play a critical role in fostering an environment of Service Excellence which we extend to all those we are privileged to serve.
If you wish to make a difference in the lives of our patients and residents APPLY NOW!
Full Time Benefits include:
- Medical/Dental/Vision
- Excellent 401k plan
- Tuition Reimbursement
- Vacation Holiday and Sick Time
- Long and Short Term Disability
- Employee Assistance Program
- Life Insurance
- Referral Bonuses
- DiversICARE - employee hardship fund
- Pay advancement program - OnShift Wallet
Diversicare provides post-acute care services to patients and residents at 46 skilled nursing and long-term care centers in five states primarily in the Southeast Midwest and Southwest United 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 Diversicares Mission to Improve every life we touch by providing exceptional healthcare and exceeding expectations.
We are guided to excellence by five Core Values: Integrity Excellence Compassion Teamwork and Stewardship as well as 12 Service Standards.
We build on trust respect customer focus compassion diplomacy appreciation and strong communication skills to shape the culture in our workplace. Diversicare team members play a critical role in fostering an environment of Service Excellence. Our Service Standards are in place to offer support. They lead us to what matters most to our company: creating a warm caring safe and professional environment for our customers and each other.
Our culture of impassioned service delivery is the Diversicare Difference.
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Responsibilities
The key role of the Clinical Reimbursement Specialist 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 addition to these responsibilities the following expectations which are not all-inclusive will guide the Clinical Reimbursement Specialist:
- Train and consult with RNACs and MDSCs 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:
- RUG Trends
- 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
Qualifications
- Current license by State Board of Nursing RNrequired.
- Minimum of 3 years ofexperience in clinical reimbursementin the long term care setting.
- Prior experience in multi-facility management strong preferred.
- Excellent communication skills; prior experience in teaching/training preferred.
- Computer skills necessary.
- ANNAC certification preferred.
Diversicare is committed to being an equal opportunity employer. Diversicare does not discriminate in employment opportunities or practices on the basis of race color religion sex (including gender identity) national origin age or disability sexual orientation citizenship marital status veteran status genetic information or any other characteristic protected by law.
(EOE)
Required Experience:
Director
Employment Type
Full-Time
