Now Hiring - Director or Clinical Reimbursement - (Cresskill), (NJ)
(CareOne at Cresskill)
Job Duties
The Director of Clinical Reimbursement assures the management of the Medicare, Managed Care and Medicaid reimbursement system for a region-specific number of skilled nursing facilities. Job duties include, but are not limited to:
Implement and direct Medicare and Medicaid auditing and systems review.
Admission pre-screening review
Admission documentation requirement review
Financial documentation requirement review
Clinical documentation assessment
Strategic selection of assessment reference dates
MDS accuracy
ADL score tracking
Denials management
RUGs management
Provide Interdisciplinary Team Training
Consolidated billing
Update facilities on trends, developments, concepts and techniques in the Medicaid and Medicare fields that affect reimbursement services
Engage facility management team in problem solving process to identify improvement opportunities and achieve solution
Facilitate effective well-organized utilization meetings, establish productive objectives and follow through with action plans
Evaluate performance of facility-based staff and make recommendations regarding staff assignments, assessment procedure and reimbursement systems. Ongoing evaluation of the effectiveness of reimbursement staff
Fee schedules
Position Requirements
Diploma and/or Degree from credentialed school of nursing. Currently licensed as a Registered Nurse in the state of practice.
Minimum of 5 years of experience in long term care.
Proven knowledge of quality improvement processes with an emphasis on Medicare, Managed Care and NJ Casemix for Skilled Nursing facilities.
Multi facility experience with management skills
Excellent oral and written communication skills.
Work processing and related computer skills.
Current licensing and credentials as required.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries
Hospitals and Health Care
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