MDS Reimbursement Director - NurseCare Buckhead : Job Details

We are seeking a MDS Director of Reimbursement to strategically lead our clinical reimbursement team. Our goal is to be a resource to our communities, providing short-term rehabilitation for a short stay with long-term success, in addition to offering a variety of skilled services.Job Summary:

The MDS Director of Reimbursement is responsible for overseeing clinical reimbursement initiatives for the company. This includes managing and evaluating clinical reimbursement staff, tracking and analyzing trends, and identifying areas for improvement and growth. The role ensures reimbursement structures are managed accurately, capturing resource utilization at all facility levels. The Director will partner with Clinical, Financial, and Rehab teams to develop and enhance clinical reimbursement tools and systems.

Essential Duties and Responsibilities:

• Develop and implement case management and clinical reimbursement programs.
• Review weekly/monthly RUG distribution and reimbursement reports, assisting in trend identification.
• Provide instruction to Facility MDS Coordinators on RAI processes and systems.
• Track, trend, and analyze current RUG scores, end splits, CMI weekly and monthly, and report findings to management.
• Assist the VP of Clinical Services in developing plans to improve clinical reimbursement and RAJ functions at facilities.
• Serve as the subject matter expert on all clinical reimbursement and RAI matters.
• Act as the corporate liaison with the VP of Rehab, reviewing RUG utilization, forecasts, ADL Index, and reimbursement utilization.
• Collaborate with the Chief Compliance Officer to ensure adherence to policies, procedures, and regulations.
• Partner with Medical Review to ensure accurate ADR submissions.
• Maintain current knowledge of OBRA regulations, licensure requirements, and other standards.
• Assess the knowledge, skills, and performance of nursing MDS staff related to coding and assessments.
• Train MDS staff on CAAs, trigger worksheets, and assessment dates.
• Identify and develop educational opportunities.
• Visit facilities routinely to review, monitor, and audit coding quality.
• Coordinate with executives and managers to scope projects, execute across functions, and develop training programs.
• Participate in recruitment, evaluation, and retention of MDS staff.

Qualifications :

• RN, Therapist, or Bachelor's Degree in Healthcare or related field.
• Five to ten years of clinical reimbursement or MOS experience.
• Proficiency with computer technology and systems.
• Extensive knowledge of MOS, documentation, state grouper, calculator fields, Medicare reimbursement, RUG IV, compliance, and eligibility.
• Strong project management skills with successful project execution experience.
• Five years of Long Term Care management experience.
• Effective communication skills with staff, physicians, and leadership, utilizing diplomacy and discretion.
• Willingness to travel to other facilities.

#J-18808-Ljbffr