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Form of workJob Description
The Director of Clinical Reimbursement (DCR) will play a key role in directing CLINICAL REIMBURSEMENT strategy across the organization. DCR will supervise the performance of the Clinical Reimbursement Specialists, supporting education and compliance systems with Prospective Payment System (PPS) management per Center for Medicare & Medicaid Services (CMS) regulation, and Management Minutes Questionnaire (MMQ) management per MA Department of Public Health (DPH) regulation and Integritus Healthcare best practice. The DCR will drive the maximization of reimbursement from: Medicare Part A, Medicare Part B, HMO`s, and State Specific Reimbursement programs (case mix or MMQ`s) per the guidelines set. This role will provide direction and supervision of the activities of the BHCS Clinical Reimbursement Team. The DCR requires close alignment with BHCS Finance function, as well as Regional Directors and Local Affiliates.
Experience: -5-7 years prior experience in a leadership role in a multi-facility post acute organization. -Leadership in directing and implementing change. -Experience in providing staff training and consultation. -Expertise in Minimum Data Set (MDS)/Care Planning and proficiency in Resident Assessment Instrument (RAI) process. -Expertise in Federal, State reimbursement programs, such as: Medicaid; Medicare/Reimbursement Utilization Groups (RUGS) IV; private insurance; Veteran`s Administration (VA) programs; bordering state contracts; et. al. B. Education and Training: (Acquired through formal education, outside study, training on jobs of lesser degree, or by any combination of these. May be expressed in terms of formal educational equivalents): -Bachelors or more advanced degree in nursing or rehabilitation. C. License, Certification & Registration: -Licensed Registered Nurse or Rehabilitation Therapist (PT, OT, SLP), American Association of Nurse Assessment Coordination (AANAC) certification as assessment coordinator (RAC-C Resident Assessment Coordinator-Certified). D. Other Requirements: -Ability to continuously interact effectively with internal and external stakeholders.
Education
· Graduate of accredited RN Program required.
Salary starting at $45.00 to $50.00 per hour based on experience
