Director of Clinical Reimbursement (Applicants can be based anywhere in Ohio)
Director of Clinical Reimbursement
CHI Living Communities is a business line of Catholic Health Initiatives (CHI) which joined with Dignity Health to form CommonSpirit Health, a nonprofit national health system committed to advancing the health of all people and dedicated to serving the common good. Offering assisted living, memory care, skilled nursing and rehabilitation with private living spaces in a beautifully-designed, compassionate environment.
The Director of Clinical Reimbursement oversees and audits MDS submissions and reimbursements to ensure accuracy and compliance, identify opportunities for improvement in MDS processes, and track RUG scores to ensure appropriate care is provided to residents. Additional responsibilities include providing assistance and education to campus MDS Coordinators related to the MDS process, MDS software functionality, and best practices; working with the clinical team to ensure compliance with all federal and state guidelines, and monitoring and reporting any process deficiencies as needed.
- Ensure an organized system and operation in the Nursing Department by oversight and audit of each campus’s admission and ongoing MDS assessments process.
- Provide best practices to campus MDS Coordinators for resident care plans, interdisciplinary care plans, and acute medical/nursing care plans related to the process of planning, implementation, and evaluation of resident care. Coordinate orientation and in-service education for campus MDS Coordinators. Review MDS records for completeness and accuracy.
- Ensure timely campus submission of MDS. Oversee coordination of Medicare PPS and Medicaid OBRA Schedule for Ohio, Wisconsin and Colorado.
- Provides case management oversight to include:
- Coordinate and verify insurance coverage and other third party eligibility
- Review managed care and insurance contracts to insure appropriate reimbursement for covered beneficiaries.
- Coordinate as needed to facilitate the intake process
- Provide oversight for levels 1 and 2 appeals process; to include timelines, documentation and follow up.
- Oversee coordination of the Restorative Programs and Staff.
Education & License:
Registered Nurse current license in at least one of the states in which we operate and ability to become licensed in additional states.
BSN degree preferred
Current RAC-CT certification required
Long term care leadership experience
Must have experience working with state of Ohio Medicaid schedule