What are the responsibilities and job description for the Director of Reimbursement Programs position at Creative Solutions In HealthCare?
Join Our Team as a Director of Reimbursement Programs
Ensure Accuracy. Maximize Compliance. Support Quality Care.
We’re seeking an experienced and detail-oriented Director of Reimbursement Programs to join our corporate team. This position plays a critical role in reviewing documentation, ensuring MDS accuracy, and supporting facilities in capturing appropriate services for maximum reimbursement. The ideal candidate has strong leadership skills, deep knowledge of nursing home regulations, and a passion for ensuring compliance and quality care.
Your Impact as a Director of Reimbursement Programs
In This Role, You Will
We’re looking for someone who:
This position reports directly to the Vice President of Clinical Reimbursement.
Equal Opportunity Employer
We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
Ensure Accuracy. Maximize Compliance. Support Quality Care.
We’re seeking an experienced and detail-oriented Director of Reimbursement Programs to join our corporate team. This position plays a critical role in reviewing documentation, ensuring MDS accuracy, and supporting facilities in capturing appropriate services for maximum reimbursement. The ideal candidate has strong leadership skills, deep knowledge of nursing home regulations, and a passion for ensuring compliance and quality care.
Your Impact as a Director of Reimbursement Programs
In This Role, You Will
- Review IV infusion documentation daily to ensure compliance with RAI guidelines and confirm MDS scheduling aligns with provided services.
- Review Respiratory Evaluations (ACPlus and Respiratory Assessment UDAs) to ensure documentation accuracy and timely MDS scheduling.
- Monitor PCC alerts daily to follow up on potential IV or respiratory therapy referrals.
- Review Glide dismissed alerts and ensure all necessary follow-ups are completed.
- Analyze Glide “Nursing Splits” for COPD with shortness of breath while lying flat, providing education to facilities when documentation is incomplete.
- Collaborate with facility leadership to ensure reimbursement practices are aligned with company policies and federal/state regulations.
- Provide education and support to facility teams to strengthen compliance and documentation processes.
We’re looking for someone who:
- Holds a vocational or advanced degree in nursing.
- Has a solid base knowledge of clinical reimbursement and MDS practices.
- Demonstrates significant leadership and management skills.
- Possesses working knowledge of nursing home and payor MDS regulations.
- Can perform duties within the outlined physical demands.
- Shows genuine care and interest in serving elderly and disabled individuals.
- Understands and complies with the Patient Bill of Rights and Employee Responsibilities.
- Comprehensive Coverage: Health, Dental, and Vision Insurance
- Extra Protection: AD&D, Short-Term Disability, Cancer, Critical Illness, and more
- Life Insurance: Whole and Term Policies
- Professional Growth: Tuition Reimbursement for continued education
- Time to Recharge: Paid Time Off
- Retirement Planning: Immediate 401(k) eligibility
- Unwavering Support: Exceptional corporate resources and leadership
This position reports directly to the Vice President of Clinical Reimbursement.
Equal Opportunity Employer
We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.