Director of Clinical Reimbursement (RN)

Position Summary

The Director of Clinical Reimbursement supports the Clinical Reimbursement Specialists (CRSs) throughout the company and provides education and assistance as it pertains to the RAI process, Medicare Regulations, Quality Measures, and the Patient Driven Payment Model (PDPM) in accordance with all applicable laws, regulations, and Life Care standards. Collects and analyzes data that can be used to assist the facilities and company with improvement efforts.

Education, Experience, and Licensure Requirements

• Have a registered nursing degree from an accredited college or university.
• Currently licensed/registered in applicable state. Must maintain an active Registered Nursing (RN) license in good standing throughout employment.
• Extensive knowledge of the RAI process, Medicare regulations, Quality Measures, and PDPM.
• Experience in managing multiple facilities.
• Knowledge of the Quality Reporting Program.

Essential Functions

• Serve as subject matter expert for Clinical Reimbursement Specialist (CRSs)/Minimum Data Set Coordinators (MDS) throughout the company and provide education, training, and support to MDS Coordinators and interdisciplinary teams.
• Oversee Clinical Reimbursement processes for assigned facilities/regions.
• Stay current on reimbursement regulations and industry changes and provide education opportunities when needed.
• Provide timely and effective education as needed regarding updates or changes to the CMS RAI Manual or skilled nursing facility regulations that impact Reimbursement.
• Answer questions related to the triple check process and assist with ADR reviews.
• Ensure accuracy and timeliness of MDS assessments and supporting documentation.
• Monitor Federal & State reimbursement accuracy.
• Conduct routine audits of clinical documentation, coding, and reimbursement practices.
• Support processes to improve positive resident outcomes and 5-star quality.
• Ensure compliance with CMS regulations, state guidelines, and company policies.
• Analyze reimbursement trends, quality measures, and financial reports and make recommendations.
• Collaborate with facility leadership to develop action plans for reimbursement accuracy.
• Assist facilities during surveys, audits, and external reviews.
• Support implementation of clinical reimbursement systems and process improvements.
• Exhibit excellent customer service and a positive attitude.
• Assist in the evacuation of patients.
• Demonstrate dependable, regular attendance.
• Concentrate and use reasoning skills and good judgment.
• Communicate and function productively within an interdisciplinary team.
• Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
• Read, write, speak, and understand the English language.
• Lift weight as deemed appropriate for the position.

Other Requirements

• Willing and able to travel, including air travel.
• Have a valid driver's license in current state with driving record that meets Life Care requirements.
• Proficient in Word, Excel, and e-mail.
• Excellent verbal and written communication skills.
• Maintain a positive attitude and positive communication supporting Life Care goals and initiatives. Must be able to follow directions of supervisor.
• Communicate and function productively with associates at the facility, regional, and division levels.
• Possess the ability to strategize and make independent decisions with respect to matters of importance.
• Knowledgeable of nursing practices and procedures as well as the laws, regulations, and guidelines governing reimbursement functions in the post-acute rehab and long-term care facility.
• Ability to implement and interpret the programs, goals, objectives, policies, and procedures of the Clinical Services department.
• Perform proficiently in all applicable competency areas.
• Maintains professional working relationships with all associates, vendors, etc.
• Maintains confidentiality of all proprietary and/or confidential information.
• Understand and follow company policies including harassment and compliance procedures.
• Displays integrity and professionalism by adhering to Life Care's Code of Conduct and completes mandatory Code of Conduct and other appropriate compliance training.

An Equal Opportunity Employer