Regional Director of Clinical Reimbursement

Brickyard Healthcare•Indianapolis, IN

12h

About The Position

We rely on and trust our Regional Director of Clinical Reimbursement to provide extensive training, analysis, direction, action plan/resolution and consultation to the facilities, district and regional teams within his/her area of specialty. Validates compliance with federal and state regulations as well as Company policy and procedures regarding state case mix/Medicare payment systems, RAI process and operations.

Requirements

RN or completion of a Bachelors Degree in a health care or related field
Three to five years of clinical experience in a long term care setting, which includes supervisory, administrative, or consultative capacities
Current knowledge of state case mix and Medicare payment systems
Capable of maintaining regular attendance
Must be able to work favorably across departments

Responsibilities

Provides consultation, training and support related to the RAI Process.
Medicare and state case mix payment system for assigned area with little supervision.
Monitors, consults, and makes effective recommendations for changes and modifications to existing facility processes, systems, policies, and practices which will assure efficient, effective and compliant state Medicaid/Medicare payment performance and RAI process completion with minimal guidance.
Responsible for training Registered Nurse Assessment Coordinator (RNAC) on accuracy and systems related to RUG mix, RAI process and Grouper calculation.
Responsible for effective action plan resolution in areas of RAI process case-mix/Medicare system and action plans to necessary parties.
Serves as a liaison between state and organization related to the state case-mix process, including electronic submission and state MDS requirements related to state payments.