Assistant Director, Clinical Reimbursement (RN), Skilled Nursing Center (FT, Days)

GENERAL SUMMARY:

Reporting to the Executive Director of Clinical Reimbursement, the Assistant Director supervises department personnel consisting of the Registered Nurse Assessment Coordinators and Restorative Nursing in the absence of the Executive Director.

Inherent in this position is assisting with the coordination of all aspects of the MDS completion, training, and submission/correction along with review for data contributing to the Quality Rating and Quality Measure Scoring. For residents utilizing a Medicaid payer source, the Clinical Reimbursement Assistant Director is responsible for assisting with coordinating and determining the resident’s acuity level on admission and while a resident of Allied Services.

The Clinical Reimbursement Assistant Director is responsible to ensure resident placement in the most appropriate RUG/PDPM level for the prospective payment systems. Routine audits of all documentation are required including GG - Functional Abilities, scoring, mood, therapy minutes/visits, care plans, etc. Along with this requirement is the management of the ARD schedules for Medicare and commercial insurances payer sources.

Type of supervision exercised: Partial: Team Leader. RNAC

EDUCATION:

Bachelor’s Degree from an accredited school of nursing preferred with R.N. licensure.

WORK EXPERIENCE:

Minimum of 5 years experience as RNAC or Clinical Reimbursement Specialist.

SPECIAL EMPLOYMENT REQUIREMENTS:

Current PA RN licensure

RNAC Certification

Must be cleared by PA State Police criminal background check.

Excellent communication and interpersonal skills

Excellent audit and review skills to develop and provide staff training

Excellent facilitator for coordination of therapy and assessment office review meetings

Knowledge of the 5-star Quality Rating and QI/QM process.

PHYSICAL DEMANDS:

Must be able to physically transport self throughout all units and into various conference rooms. Light to moderate work: Duties requiring exerting up to 25 lbs of force occasionally or a negligible amount of force frequently to lift, carry, push and pull rolling carts with charts.

ACCIDENT OR HEALTH HAZARDS:

Potential exposure to communicable disease via air, blood or contact.

WORKING CONDITIONS:

Works in a well-lit office and multiple conference rooms. Also, visits in room with residents for Medicare non-cover notifications, resident interviews, etc.

CHARACTERISTIC DUTIES & RESPONSIBILITIES OF JOB:

E = Essential Element NE = Nonessential Element

50% Verifies and completes MDS and care plans. assists with management of the Medicare ARD scheduling and coordinates all requirements with the Therapy, Restorative staff and Assessment Departments via routine monitoring and facilitation of interdepartmental review meetings to include the appropriate look back periods and accurate functional abilities completion. Ensures compliance with all federal and state regulations related to MDS coding and billing. (E)

• 25% Oversees the completion of the MDS process including the Care Area Assessments (CAAs) leading into the resident plan of care. (E)
• 12% Works with the Executive Director to ensure provision of staff oversight and assists as needed with audits of MDS and RUG and/or PDPM contributing data elements, including but not limited to Functional GG scoring, to ensure placement into the most appropriate reimbursement categories. (E)
• 8% Works with the Executive Director to ensure supervision of all department staff including orientation. Provides ongoing in-servicing of regulatory and reimbursement areas to ensure staff if up-to-date on changes. (E)
• 1% Serves as a backup to the Financial Coordinator to assist with insurance reviews as needed. (E)
• 2% Works with the Executive Director to monitor and trend data from MDS as it relates to the 5-star quality rating process/QI/QMs and effectively communicates results to Administrator and other related team members. (E)
• 2% Completes departmental QI reports. (E)