5+ years of experience in clinical reimbursement or related field
Thorough knowledge of Medicare, Managed Care, and Medicaid payment systems
Strong analytical skills with experience in audits and compliance assessments
Excellent communication skills for consulting with diverse teams
Ability to travel across multiple states for facility visits
Experience in training and supporting staff in reimbursement processes
Responsibilities
Provide consultation and training on Medicare and Managed Care payment systems
Audit and analyze compliance with federal and state regulations
Identify and promote best practices for facility reimbursement processes
Analyze data to report trends in reimbursement performance
Collaborate with facility teams to resolve performance deviations
Communicate recommendations to upper management for facility improvements
Act as a liaison for state case-mix processes and electronic submissions
Benefits
Comprehensive healthcare coverage
Travel reimbursement for facility visits
Professional development and training opportunities
Collaborative work environment with dedicated teams
Flexible work schedule with remote options
Full Job Description
The Regional Director of Clinical Reimbursement provides extensive training, analysis, advice and consultation to the facilities and teams within his/her area of responsibility. Ensures compliance with federal and state regulations, as well as Company policy and procedures regarding state case mix/Medicare and Managed Care payment systems. 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/Managed Care payment performance.
Travel will be necessary to facilities in Wisconsin, Tennessee, Kentucky, and Florida.
Provides consultation, training and support concerning the Medicare, Managed Care and state case mix payment system for the assigned area.
Analyzes systems and processes to determine that federal and state regulations as well as company policies and procedures are followed. Promotes compliance by performing periodic audits of MDS assessments, supporting documentation, and other relevant data.
Recognizes, advises and promotes facility best practices and systems for dealing with state case mix/Medicare and Managed Care payment systems.
Studies, analyze and reports period over period information and systems in order to identify trends and deviations from results in Medicare, Managed Care and State Case Mix Index and takes appropriate actions.
Works in conjunction with teams to resolve issues effecting deviations from expected results. Recommends changes and performs follow-up to ensure that those recommendations are effectively implemented and monitored for appropriateness.
Regularly communicates to management outside the facility on recommendations made to facility management to ensure proper implementation and follow-up.
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 payment.
Assists in the recruitment/interview process for MDS Vacancies
