Director of Clinical Documentation and Reimbursement

Director of Clinical Documentation and Reimbursement

Compensation: $150K per year

Job Type: Full-Time, Monday–Friday, On-Site

Our client, is seeking an experienced and compassionate Director of Clinical Documentation and Reimbursement to oversee clinical operations across multiple residential care settings. This senior leadership role is pivotal in ensuring high-quality, resident-centered care while maintaining full compliance with regulatory requirements.

Position Overview

The Director of Clinical Documentation and Reimbursement is responsible for the overall operational and strategic planning of the Clinical Documentation and Reimbursement (MDS) Department and Health Information Management (HIM) Department. This position will ensure that all operational and regulatory requirements are maintained related to the MDS and Resident Assessment Instrument (RAI) process.

Key Responsibilities

• Collaborates with other department heads to utilize objective information from the clinical documentation to drive the highest quality of care.
• Leads the strategic planning development related to Medicare/ Medicaid reimbursement and Managed Care Case Management.
• Monitors and incorporates facility wide education plans related to MDS updates, payment reforms and changes to quality measures.
• Analyzes and tracks data related to MDS item sets to support organizational quality assurance/ performance improvement plan.
• Audits and tracks all aspects of the RAI process to ensure performance is reflective of NYS DOH regulatory statues and standards.
• Provides oversight and supervision to all MDS and HIM staff.

Qualifications

• Bachelor’s Degree in Nursing required, Master’s Degree preferred.
• NYS RN license required with required following experience a plus
• Minimum 3 years of RAI process and SNF reimbursement experience.
• Completion of New York State approved PRI assessor program preferred, RAC-CT preferred.
• Knowledge of Federal and State regulations and NYS nursing standards required. Familiarity with Medicaid and Medicare regulations required.
• Required Experience with data extraction and manipulation required.
• Proven expertise in managing SNF-based quality metrics, including Quality Measures (QM), Quality Reporting Programs (QRP), and Value-Based Purchasing (VBP) models to drive facility-wide performance and 5-star rating improvements.
• Demonstrated strong analytical, project management Skills
• Effective oral and written communication and interpersonal skills required. Must be able to communicate with clients and employees of all backgrounds and educational levels.
• Ability to understand industry specific content and requirements required
• Demonstrated ability to lead both small and large teams effectively and be comfortable presenting and communicating to people across the organizational structure and beyond.

Benefits

• Health insurance
• Retirement plans
• Paid time off
• Professional development opportunities.

Disclaimer

This job description is not intended to be an exhaustive list of duties, responsibilities, or qualifications. Management reserves the right to modify or assign other duties as necessary.

If you're excited about the potential of this role, we’d love to hear from you!