Director of Clinical Reimbursement, RN

Friendship is looking for a Full Time Director of Clinical Reimbursement, RN to join our Friendship team. The Director of Clinical Reimbursement is responsible for maintaining open communication with MDS Coordinators, Coder, and IDT (Interdisciplinary team) members of Friendship Health and Rehab Center, Friendship Health and Rehab Center- North, and Richfield Health Center and establish/enforce procedures to support RAI practices are maintained and followed under CMS and state regulations, while ensuring billing is completed accurately, and reflective of care for the residents within the facility accurately capturing the correct Case Mix Index (CMI).

Roles & Responsibilities: 

• Follow all regulations federal or state in regards to the RAI process, while obtaining education on any changes to processes/regulations and provided education back to the MDS team
• Track skilled residents’ benefit to ensure it is utilized appropriately through communication with insurance providers via phone, fax, and/or email for updates per the provider once initial authorization is obtained by billing department under Medicare and individual insurance policies and regulations regarding skilled stay
• Analyze aspects of resident’s individual needs and to facilitate collaboration of the interdisciplinary team to develop Resident Specific Obtainable Goals to enable the resident to achieve their highest level of functioning through the RAI process
• Coordinate and track any medical records audits related to review of skilled services provided by the facility; such as but not limited to ADRs, ZPICs, and Manage Care Insurances
• Attend or delegate attendance of Skilled weekly meetings as needed
• Supervise and manage MDS Department and Coder under the facility handbook’s policies and procedures for payroll, approving time off, annual evaluations, and disciplinary actions as needed
• Monitor CMI (RUG/PDPM) scores and conduct audits to monitor and validate information; present information to QA committee with plan of corrections as needed
• Assist with Quality Measure review and management with audits of MDS assessments, software reports, and attending meetings related to QA processes

Qualifications: 

• Nursing Degree from an accredited institution or equivalent graduation from an approved RN program, required
• Valid, board certified, active Virginia license to practice as an RN, required
• MDS 3.0 experience preferred but not required
• Minimum of 3 years’ experience in MDS/RAI coordination, required
• Experience in Long-term Care environment preferred

Benefits for Full Time Positions:

• 401(k) retirement plan along with employer match
• Health Insurance
• Dental Insurance
• Vision Insurance
• Flexible Spending Account
• Paid Time Off
• Employee Assistance Program
• Education Assistance
• Company Paid Life Insurance
• Voluntary insurance (additional life insurance, accident insurance, critical illness, short term disability)