Clinical Reimbursement Director

Turenne & Associates•Montgomery, AL

3d•Onsite

About The Position

The Clinical Reimbursement Director in our Skilled Nursing Facility (SNF) oversees and coordinates the Minimum Data Set (MDS) process and ensures accurate and timely completion of the MDS assessments. Additionally, the PDPM Coordinator/MDS Coordinator is crucial in managing the Patient-Driven Payment Model (PDPM) to optimize reimbursement and support the facility's financial goals.

Requirements

Registered Nurse (RN) required.
In-depth knowledge of the MDS assessment process, coding guidelines, and federal regulations related to MDS and reimbursement (e.g., PDPM).
Prior experience in MDS coordination and familiarity with MDS software systems.
Strong understanding of the PDPM payment model and its impact on reimbursement in the SNF setting.
Excellent analytical skills and attention to detail in assessing, coding, and documenting resident information.
Proficient in using computer software and applications for data management and reporting.
Ability to collaborate effectively with the interdisciplinary team and communicate complex information to staff members.
Strong organizational and time management skills to meet MDS assessment and reporting deadlines.
Knowledge of quality assurance and performance improvement principles.
Familiarity with electronic health record (EHR) systems and healthcare technology.
Ability to adapt to changes in regulations and guidelines related to MDS and reimbursement.
Must possess and maintain any and all necessary active and unencumbered certifications, degrees, or licenses in the necessary state, to the extent the position requires such certifications, degrees, or licenses.

Responsibilities

Oversee the MDS process and ensure compliance with state and federal regulations.
Coordinate and manage the completion of the MDS assessments, including the initial, significant change, quarterly, and annual assessments, in collaboration with the interdisciplinary team.
Understand and stay updated on the PDPM guidelines and requirements.
Collaborate with the interdisciplinary team to ensure accurate coding and documentation to support appropriate reimbursement under the PDPM system.
Review residents' medical records, observe their conditions, and interview residents and their families to gather necessary information for MDS assessments.
Accurately complete MDS assessments and other required documentation within designated timeframes.
Collaborate with the interdisciplinary team to develop individualized care plans based on MDS assessments and residents' needs.
Ensure care plans are regularly reviewed, updated, and implemented to support quality care and maximize resident outcomes.
Conduct audits and quality checks on MDS assessments and documentation to ensure accuracy, completeness, and compliance with regulations.
Identify areas for improvement and provide education and training to staff as needed.
Work closely with the nursing staff, therapists, social workers, and other healthcare professionals to gather information, share updates, and ensure accurate and comprehensive assessment and documentation of residents' conditions and care needs.
Analyze MDS assessments, coding, and documentation to identify opportunities for optimizing reimbursement under the PDPM system.
Collaborate with the financial team to monitor reimbursement trends, address coding and documentation issues, and maximize financial outcomes.
Provide education and training to staff on MDS assessment requirements, coding guidelines, and PDPM documentation best practices.
Stay updated on changes in regulations and guidelines and communicate them to the interdisciplinary team.
Ensure compliance with federal and state MDS assessments, documentation, and reimbursement regulations.
Stay informed about changes in regulations and guidelines and implement necessary updates in MDS processes and documentation practices.
Collect and analyze data related to MDS assessments, reimbursement, and resident outcomes.
Generate reports and communicate findings to the management team, highlighting areas for improvement and strategies for enhancing resident care and financial performance.
Must demonstrate the knowledge and skills necessary to provide care appropriate to the age-related needs of the residents served.
Must be a supportive team member, contribute to and be an example of teamwork and team concept.
Must possess the ability to make independent decisions when circumstances warrant such action.
Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the general public.
Must be able to relate information concerning a resident’s condition.
Must not pose a direct threat to the health or safety of other individuals in the workplace.
Must be able to move intermittently throughout the workday.
Must be able to read, speak, and understandably write the English language.
Must be able to cope with the mental and emotional stress of the position.
Must function independently, and have flexibility, personal integrity, and the ability to work effectively with residents, personnel, and support agencies.
Must meet the general health requirements set forth by the policies of this facility, which include a medical and physical examination if the position requires.
Must be able to relate to and work with the ill, disabled, elderly, emotionally upset, and, at times, hostile people within the facility.
Must be able to push, pull, move, and/or lift a minimum of 50 pounds to a minimum height of 5 feet and be able to push, pull, move, and/or carry such weight a minimum distance of 50 feet.
May be necessary to assist in the evacuation of residents during emergencies.
All Other Duties as Assigned.