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Director Of Clinical Reimbursement

Company: Dimensions Home Health Care
Location: Minneapolis
Posted on: June 13, 2021

Job Description:

Duties and Responsibilities

  • Interface with community leadership and clients serving as a content expert for Clinical, MDS and reimbursement
  • Create strategies and core processes to capture appropriate reimbursement and improve quality measures
  • Oversee managed care/third-party contracts and partner with the Health Dimensions Revenue Professionals to negotiate contacts
  • Oversee compliance with policies and procedures as it relates to reimbursement systems to ensure compliance with MCO's, federal and state programs.
  • Conduct audits at communities to assure standards, policies and procedures are being followed
  • Oversee the training of new MDS staff on software and organizational policies and procedures
  • Assist in the advancement software and processes as it relates to clinical, billing and the MDS
  • Remain informed regulatory changes and develop and implement procedures for communities and clients to remain in compliance
  • Maintain current knowledge of market trends, expectations and changes in regulation, policy, and practice as it relates to the MDS, quality measures (QMs), payer reimbursement, and compliance.
  • Case mix reimbursement
  • RAI process
  • Government payer, regulatory and legislative changes related to reimbursement, etc.
  • Managed Care and 3rd party contract reimbursement
  • 5 Star, QAPI and QM's

  • Provide education and auditing of reimbursement policies and procedures including documentation, compliance, and operations
  • Provide state case mix education and audits on documentation and optimization
  • Provide on-site support services, consultation, and recommendations for communities and clients, as requested
  • Provide regular monitoring of facility performance and report on benchmarked performance
  • Conduct group and individual training and education sessions
  • Assist with prep surveys on auditing MDSs, CAAs, care plans and quality measures and provide training, as needed
  • Develop and maintain professional relationships and memberships as appropriate

Required Knowledge, Skills, Abilities, and Experience

  • Registered Nurse Degree, with continuing education in MDS
  • 5 years' experience with MDS, including analysis and staff education
  • Previous multi-facility management experience.
  • MDS Certification through AANAC.
  • AANAC certified trainer, preferred.
  • Point Click Care experience, preferred.
  • Strong oral, written and interpersonal communication skills
  • Ability to work independently and have strong self-initiative
  • Ability to travel approximately 80%
  • Strong supervisory and leadership skills
  • Ability to develop and maintain positive working relationships with clients, colleagues, employees, and contractors
  • Adherence to Health Dimensions Revenue Professional's values of hospitality, stewardship, integrity, respect, and humor
  • Ability to view the business from the bigger picture perspective
  • Excellent problem resolution skills and decision-making ability
  • Computer proficiency in Microsoft Office
  • Ability to work well under pressure, manage multiple projects simultaneously, and meet deadlines

Keywords: Dimensions Home Health Care, Minneapolis , Director Of Clinical Reimbursement, Other , Minneapolis, Minnesota

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