Christian Care Communities, Inc.

Dir Clinical Data Reimbursement

US-KY-Louisville
1 month ago(11/17/2017 4:20 PM)
ID
2017-2120
# of Openings
1
12710 Townepark Way
Type
Regular Full-Time
Shift
Day

Overview

Founded in 1884, Christian Care Communities is Kentucky’s largest faith-based not-for-profit provider of affordable senior retirement living and long-term care for Older Adults. Our statewide network of senior living communities provides more than a place to live—we provide a place to call “home.” Christian Care Communities serves Older Adults through an extensive network of senior communities and services, including: independent living, assisted living, skilled nursing care, short-term rehabilitation, long-term care and adult day care.

 

Top Reasons Why You Want to Work for Christian Care Communities as a Dir Clinical Data Reimbursement (Senior Leader):

  • Competitive Pay
  • Generous Time Off
  • 7 Holidays / +1 Floating Holiday
  • Medical, Dental and Vision Insurance packages
  • Comprehensive Wellness Program with Incentives
  • Paid Group Term Life Insurance
  • Voluntary Life Insurance
  • Short-Term Disability Employee Assistance Program
  • 401(k) and 403(b)
  • Education Assistance after 6 months of employment
  • Workplace Leaders in Health and Wellness
  • Direct Deposit/Weekly Pay (Pay Active)
  • $$$ Referral Bonus $$$
  • Shift Differential
  • Uniform Assistance
  • Discounted Meals
  • 9 Chaplains to Support Residents/Employees
  • Our leadership is Involved
  • Tremendous Growth Opportunity
  • Challenging and Rewarding Work Environment
  • Heart to Heart Emergency Assistance
  • Paid orientation and much more……

Responsibilities

 

The Director of Clinical Data and Reimbursement is responsible and accountable for overseeing the clinical data and reimbursement program for all health centers in compliance with all applicable laws, regulatory and organizational standards

 

  • Reviews and analyzes reimbursement documentation and facility specific data assessment, Minimum Data Sheets (MDS) to identify any gaps in the effectiveness of the process for all health centers.
  • Conducts regular onsite observation of practices at each health center to determine conformity with policies and procedures related to data collection and accuracy.
  • Evaluates internal processes, determines opportunities for process improvement, and creates strategies and implements processes for maximizing clinical and financial outcomes.
  • Validates on going compliance with clinical reimbursement processes through regular reporting to the CEO based on observations at the health centers.
  • Provides proactive consulting and facilitation on requests for additional records and other clinical needs relating to payment audits with payors.
  • Consults and advises health center administrative and MDS staff with ongoing guidance to enable accurate determination of coverage for maximum utilization of resident’s/patient’s benefits.
  • Assists MDS staff with understanding Medicaid case mix, quality measures and Medicare RUGs.
  • Updates MDS staff on regulatory changes related to MDS, Medicaid, Medicare and Care Planning.
  • Tracks all additional documentation requests (ADRs) to ensure compliance with timing and transmission of supportive information as well as analysis of data precipitating ADRs.
  • Plans and facilitates appeals process on all denials in coordination with the therapy company.
  • Reviews and coordinates Prospective Payment Systems (PPS) and case mix data to ensure appropriate utilization reimbursement for care provided to residents/patients.
  • Travels and maintains a presence with each community location and ensures each has the resources needed for achieving goals.
  • Develops and promotes key working relationships across the organization related to the assigned functional area.
  • Develops, implements, and provides orientation, continuous education and training and development programs for new and existing MDS staff as needed.
  • Identifies potential case mix revisions; analyzes data and assists Executive Directors in submissions.
  • Works with the therapy company and Business Office Liaisons on recoupments and indemnifications.
  • Communicates with Insurance Companies to receive ADR status updates.

  • Personifies outstanding customer service to co-workers, MDS staff, customers and vendors by acting as a subject matter resource in a timely, considerate and friendly manner, always maintaining the “Golden Rule” approach; practices patience and kindness.
  • Actively engages in meetings, events, workshops, or retreats as a member of the Leadership Roundtable Team (LRT).

Qualifications

Dir Clinical Data Reimbursement (Senior Leader) Work Hrs./ Shifts:

  • Full Time / Day Shifts

What will you need as a Dir Clinical Data Reimbursement (Senior Leader)?

  • Required Education:               Associate’s degree nursing, or related field from an accredited college or university
  • Preferred Education:               Bachelor’s degree in nursing, or related field from an accredited college or university
  • Required Experience:              5 years’ experience in risk management, consulting or clinical setting
  • Preferred Experience:             5 years’ experience in medical records; experience in a long-term care, hospital or healthcare environment

Business travel is a requirement of position: proof of valid driver’s license with a clean driving record. If personal vehicle is used to transport self or others; proof of insurance of $100,000 single limit of liability.

  •  

Christian Care Communities, Inc. is strongly committed to the principle of diversity and providing an equal employment opportunity in all terms and conditions of employment. All employment decisions are based on business needs, job requirements and individual qualifications, without regard to race, color, religion, gender, national origin, disability, age (40 and over), genetic information, or any other characteristic protected by federal, state or local law.

Options

Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
Share on your newsfeed