• Excelerate Healthcare
  • $175,290.00 -175,290.00/year*
  • Bergenfield , NJ
  • Executive Management
  • Full-Time
  • 30 W Clinton Ave

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Summary/Objective In keeping with our organization's goal of improving the lives of the Residents we serve, the VP of Clinical Reimbursement assures the management of the Medicare, Medicaid, and all 3rd party billing (Managed Care). This position is responsible for regulatory compliance and quality improvement efforts to ensure that the facilities maximize the reimbursement to which they are entitled. This position serves as a role model for ethical business practices, a consultant for assigned facilities and works to ensure that the services offered exceed federal, state, and company standards.

The VP of Clinical Reimbursement will encompass and hold responsibility for the functions listed below as well as all job functions for the Regional Assessment Coordinator.

Essential Functions Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  1. Engage facility management team in problem solving processes to identify opportunities for improvement pertaining to facility reimbursement.
  2. Work with staff that coordinates the case mix submission process to ensure maximum legitimate reimbursement provided for services delivered to residents in each facility.
  3. Clear understanding of reimbursement methodology with regards to Medicare, Medicaid, and Managed Care Plans, (in all applicable facilities).
  4. Constantly improving the UR process and ensure a smooth weekly meeting.
    • Must attend at least 1 UR meeting at each building, per month. This will allow this position to gain a clear understanding of UR process in each facility.
  5. Staying up-to-date with all industry updates and regulation changes.
  6. Provides a high-level of technical competency and serves as a subject matter expert regarding documentation, coding, billing, reimbursement, and compliance management.
  7. Provide leadership and training for multiple MDS Coordinators, ensuring standards of practice are uniformly implemented across the corporation.
  8. Conduct educational in-services as needed.
  9. Responsible for ADR process and developing the tracking tools to manage this process. Ongoing; ensuring these tools are utilized/revised for optimal outcomes.
  10. Implement and direct Medicare/Medicaid/Managed Care auditing and systems review for:
    • Clinical documentation requirements
    • Strategic selection of assessment reference dates
    • MDS accuracy
    • Denials Management
    • RUGs Management
  11. Provide interdisciplinary team training for:
    • MDS and PCC training
    • Physician Certification completion
    • NOMNC completion
    • Documentation Requirements
    • RUGs Groups
    • Admission strategies
    • Managed Care Contracts and updates
    • HIPPS coding
    • Consolidated Billing
  12. Financial Analysis: Review corporate reports for trends, monitors outcomes and directs facility in improving outcomes in the following areas:
    • Rate projections
    • Daily RUGs distribution
    • Length of stay analysis
    • Assist in Part B program development
    • CMI projections
    • 30-day readmission rates to individual hospitals and company at large
  13. Clinical Analysis: Implements and maintains processes related to reimbursement.
    • Monitor daily Case Management PPS meeting
    • Month end Triple Check
    • CMI meetings
  14. Mandatory Reports include:
    • Medicare Caseload Report- completed daily
    • ADL Compliance Reports- completed weekly
    • ADL Index Reports- completed weekly
    • CMI Reports (for applicable facilities)- completed weekly
    • RUG Summary Reports- Completed monthly
    • RUG Trends Reports- Completed monthly
    • Weekly Report submitted to CFO, COO, CEO; communicating all action directly related to job items listed and facility reimbursement.
    • This position must develop a reporting mechanism that allows MDS coordinators to report on a weekly basis. From these reports a summary to be submitted monthly to CFO, COO, CEO.
  15. Serve as area resource for RAI.
  16. Assist Administrators in recruitment, orientation, evaluation, and retention of MDS Coordinators.

Associated topics: analyst, cash, corporate banking, equity trading, expense, financial controller, financial planning, financial services, invest, revenue

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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