Director of Clinical Reimbursement

About the role

The Regional Director of Clinical Reimbursement provides extensive training, analysis, advice, and consultation to facilities and teams within their area of responsibility. This role ensures compliance with federal and state regulations, as well as Company policy and procedures regarding state case mix, Medicare, and Managed Care payment systems. Travel to facilities in Wisconsin, Tennessee, Kentucky, and Florida is required.

Responsibilities

• Provide consultation, training, and support concerning Medicare, Managed Care, and state case mix payment systems for the assigned region.
• Analyze systems and processes to ensure adherence to federal and state regulations, as well as company policies and procedures.
• Promote compliance by performing periodic audits of MDS assessments, supporting documentation, and other relevant data.
• Identify, advise, and promote facility best practices and systems for state case mix, Medicare, and Managed Care payment systems.
• Study, analyze, and report period-over-period information to identify trends and deviations in Medicare, Managed Care, and State Case Mix Index, and take appropriate actions.
• Collaborate with teams to resolve issues affecting deviations from expected results, recommend changes, and perform follow-up to ensure effective implementation.
• Regularly communicate recommendations to management outside the facility to ensure proper implementation and follow-up.
• Serve as a liaison between state entities and the organization regarding the state case-mix process, including electronic submission and state MDS requirements related to state payment.
• Assist in the recruitment and interview process for MDS vacancies.