Regional Director of Clinical Reimbursement in CT - Wachusett Healthcare

Wachusett Healthcare is a skilled nursing facility organization with multiple facilities in Connecticut.  The organization specializes in short-term rehabilitation, long-term care, memory support, respite services, and palliative & hospice care.  They pride themselves on providing quality care to community residents and continue to elevate their clinical capabilities through partnerships with post-acute providers.  Discover the difference of quality care and join the Wachusett team!

The Regional Director of Clinical Reimbursement is responsible for overseeing  MDS, PDPM, CMI, & QM compliance at each Wachusett’s facility.

This individual is the key participant of the interdisciplinary team, assisting in ensuring quality of care, continuity of services, and individualized patient-centered plans and goals; while ensuring services are provided at the highest level of revenue integrity that are in compliance with all state and federal regulations for MDS completion and coding conventions.

Primary Responsibilities:

·       Conducts audits and performs ongoing evaluations from pre-admission through discharge to ensure an appropriate reimbursement level for each resident. Evaluates care to ensure that services and products match benefits available

·       Reviews medical records, care plans, charting to ensure documentation supports care provided and reimbursement level.

·       Monitors facility practice to ensure compliance with guidelines for participation in Medicare, Medicaid and other benefit programs. Initiates action needed to ensure compliance.

·       Oversees quad check prior to release of claims. Tracks and reviews all claim denials to identify problems.

·       Assists in preparation and timely submission of any additional development requests, reconsiderations and administrative law judge hearings.

·       Review state MDS validation reports to identify issues and/or processes to ensure accuracy of submitted MDS’s.

·       Oversees and provides education, intervention and support for Medicare, PPS, RAI, state specific and special contract reimbursement.

·       Monitor discharge and re-entry tracking forms are completed accurately and timely.

·       Monitor and review modifications of assessments in accordance with CMS Correction Policy.

Qualifications:

• Active RN license in the State of CT
• Experience with MDS, PDPM, CMI, & QM
• Knowledge and understanding of Electronic Medical Record (EMR), PDP, MDS 3.0, Medicaid and Medicare requirements
• Deadline driven, exceptionally detail-oriented individual with strong organizational skills, analytical capabilities and the ability to make decisions independently
• Excellent written and verbal communication and interpersonal abilities
• Ability to work effectively and influence others in a multidisciplinary team environment

Benefits:

·       401K Plan

·       Medical, Dental and Vision

·       Employer-paid Life Insurance

·       Competitive Paid Time Off Policy