RN Director of Clinical Reimbursement

Job Description

Job Description

RN Director of Clinical Reimbursement

Masonicare Health Center - Wallingford, CT

Day Shift / 40hrs / wk

Responsible for coordinating, managing and ensuring the accuracy / capitalization of the facility’s reimbursement from its payor sources. Responsible for the coordination of the Resident Assessment Instrument (RAI) process.

Essential Duties and Responsibilities :

• Manages the facility’s RAI processes to capture accurate resident related data as well as work with all resident service department s involved in the RAI process to maximize resident’s full reimbursement potential.
• Provides / ensures accurate documentation of all services in order to maximize accurate reimbursement from all payor sources.
• Completes all performance reviews with staff along with hiring of new staff.
• Selects, trains / orients and assigned department staff. Develops standards of performance, evaluates performance, and initiates or makes staff recommendations.
• Reviews facility quality indicators, assisting as needed with identifying strengths and weaknesses of data and how it relates to facility care practices
• Manages the patient’s Medicare benefit by communication of skilled needs to the patient, family and interdisciplinary care team.
• Organize and participate in the daily Medicare meeting, utilization review and monthly end of close meetings.
• Assists with Medicare denial claims / reviews when need is identified by billing office.
• Keeps abreast of changes in the Medicare, Medicaid and managed care areans and MDS / RAI processes through journal reading, outside in-services an other sources.
• Continually upgrades and makes changes in job area to assure that departments meet the needs to the changing market, federal and / or state mandates.
• Participates in and attends all mandatory Masonicare in services and departmental staff and inservice meetings.

Education : Registered Nurse with a current Connecticut State license and a BSN or MSN graduate degree from an accredited school of nursing preferred.

Experience : Requires at least 3-5 years experience in geriatric nursing; Requires at least two (2) years experience with federal Medicare / Medicaid and Managed Care reimbursement systems with a thorough working knowledge of the MDS and RAI process; Requirese a working knowledge of OBRA regulations as they relate to Skilled Nursing facilities; Requires strong working knowledge of statistics, data collection, analysis and presentation.

Certificates, Licenses, Registrations : Current Connecticut State RN licensure required.

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Day Shift / 40hrs / wk