Director Of Clinical Reimbursement, Nurse

Overview

The Director of Clinical Reimbursement RN is a nursing position responsible for the coordination and leading all aspects of the areas of RAI/MDS assesment and reimbursement process for Jones-Harrison Long-term care skilled nursing community located in Minneapolis, MN.

• 80 Hours Per Two Week Pay Period
• Salaried, Monday-Friday
• Generous Benefits Package: https://www.ebenezercares.org/employee-benefits  (paid time off, medical, dental, matching retirement, wellness reimburement, college education funds)

Celebrating 135 years of service, Jones-Harrison Senior Living is conveniently located close to the metro bus stops off Cedar Lake Ave./Drew Ave. S. and Cedar Lake Ave./France Ave. S. in Minneapolis, MN. The Jones-Harrison community offers Assisted Living, Memory Care, Skilled Nursing and Long-Term Care with a beautiful view of Cedar Lake and pristine grounds.  This community features 53 Assisted living, 9 memory care apartments, 120 skilled and long term care beds. Join our team of dedicated employees who share in our mission to help our seniors heal, discover, and educate for longer healthier, more meaningful lives!  Managed by Ebenezer. 

 

When you come to work at Ebenezer, we promise to support your growth, honor your strengths and empower you to make a difference in the lives of others. Named as a Star Tribune Top Workplace for the 12th time, Ebenezer is Minnesota's largest senior living organization with over 100 years of excellent service, and we're growing at an outstanding rate!

Responsibilities/Job Description

Oversees MDS assessment/Care Planning as required by State and Federal law

• Develops and/or assures accuracy of care plan process. 
• Oversees coordination of all required Resident Assessment Instruments per state and federal regulations to ensure timely completion. 
• Monitoring of input into the MDS (Minimum Data Set)/RAI process to ensure accuracy. 
• Acting as resource to all team members when questions arise on how to answer questions on the MDS. 
• Mentoring, re-educating and training of RAI sections to team members as appropriate to increase competency in their designated roles. 
• Completes nursing sections of MDS, CAA. 
• Distributes updates and schedules for MDS completion to IDT and ensures timely completion. 
• Notifies Department Managers and/or Administrator of significant issues or persistent problem areas that have impact on star rating, Quality indicators and re-imbursement at a minimum. 
• Updates resident diagnosis as applicable. 
• Actively involved at the IDT meetings. 
• Follows CMS /RAI for corrections as instructed. 
• Backs-up and assists Medical Records Coordinator for ICD-10 coding.

Manages reimbursement system

• Assures timely transmissions of all required MDS's per state and federal regulations. 
• Manages follow-up of all transmission error issues in timely manner and in compliance with CMS regulations. 
• Maintaining timely communication with the accounts receivable department regarding completion of RAI process as it relates to billing.   
• Collaboration with AR and clinical departments on the process and compliance with related state and federal regulations. 
• Completes audits to assure accuracy of PDPM payment level.  
• Monitors PDPM payment levels.  
• Reviews Validation reports and makes appropriate corrections with IDT members when appropriate. 
• Informs IDT members of validation errors as appropriate. 
• Understands, PDPM payment level to insure maximum payment. 
• Participates and plays an active role in Triple check.  

Stays current regarding long term care trends and state/federal regulations

• Attends outside seminars, webinars, focusing on current MDS changes and regulations. 
• Attends ongoing educational offerings of topics pertaining to assigned duties to remain current in areas of responsibilities.  
•  Attends mandatory in-services. 
• Subscribes trade magazines and websites to stay up to date with changes. 
• Assist with incorporating new learning into practice by revising policies and procedures. 
• Communicates new information to IDT. 

Uses Quality Indicator data, other reports to improve Quality Performance and MDS accuracy

• Assists IDT in determining MDS accuracy issues related to Quality Indicators. 
• With appropriate IDT members, develops and implements appropriate Action Plans to correct MDS accuracy issues. 
• Participates in Quality Assurance Committee meetings as directed by Administration. 

Provides educational training related to MDS/RAI process to all staff on an ongoing basis and as needed. 

Qualifications

Required:

• Vocational/Technical Training or Associate Nursing Degree

• RN Licensure/Registered with the MN Board of Nursing (may initially hold LPN licensure but RN licensure required within 90-days after hire date) 

• Current Basic Life Support (BLS) for Health Care Provider from American Heart Association (AHA) or American Red Cross

  • Accepted certifications as follows -AHA:BLS for Healthcare Providers (CPR & AED) Program orBLS Provider - BLS Instructor. American Red Cross:CPR/AED for Professional Rescuers and/or Healthcare Providers,Life Guarding First Aid/CPR/AED 

Preferred: 

• ANACC Certification

Employment Type: OTHER