Area Director of Clinical Reimbursement
Area Director of Clinical Reimbursement
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Job Description
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 Diversicares 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.
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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 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.
Required Experience:
Director
Employment Type
Full-Time
