Director Of Clinical Reimbursement

Overview

• Lead the clinical reimbursement department, driving compliance and operational excellence in healthcare documentation and reimbursement processes.
• Develop and implement strategic plans for Medicare/Medicaid reimbursement and managed care case management.
• Collaborate with interdisciplinary teams to enhance care quality through optimized clinical documentation practices.
• Monitor industry updates and implement education plans related to MDS updates and payment reforms.
• Analyze MDS data to support quality assurance initiatives and performance improvement strategies.
• Audit and oversee RAI processes to ensure compliance with state and federal regulations.
• Supervise and mentor MDS and HIM staff, fostering professional growth and performance excellence.
• Contribute to organizational success through effective leadership and strategic planning initiatives.

Key Responsibilities & Duties

• Collaborate with teams to leverage clinical documentation for improving patient care quality.
• Lead strategic planning for reimbursement processes and managed care case management.
• Develop and implement facility-wide education plans for MDS updates and regulatory changes.
• Analyze MDS data to support quality assurance and performance improvement initiatives.
• Audit RAI processes to ensure compliance with regulatory standards and best practices.
• Provide oversight and supervision to MDS and HIM staff, ensuring operational excellence.
• Ensure adherence to federal and state regulations and nursing standards.
• Communicate effectively across organizational levels and with diverse stakeholders.

Job Requirements

• Bachelor’s Degree in Nursing required; Master’s Degree preferred.
• Active RN license with substantial experience in RAI processes and SNF reimbursement.
• Completion of New York State approved PRI assessor program preferred.
• RAC-CT certification preferred, demonstrating expertise in clinical reimbursement.
• Strong knowledge of federal and state regulations and nursing standards.
• Experience with Medicaid and Medicare regulations and SNF-based quality metrics.
• Proven analytical and project management skills for strategic planning.
• Exceptional communication and interpersonal skills, with a focus on team leadership.