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Director of Clinical Reimbursement

Pacific Wellness Centers Albuquerque, NM

Job Type: Full-Time. Regions Covered: New Mexico, Arizona, and Indiana. Benefits Offered: Healthcare Dental Vision PTO 401k Your Job Dutiies. • Is an integral part of the management teams and as such works hand-in-hand with the Regional Vice President and QA Nurses to clinically support the facility. • Provides in-service and training on QI/PPS/Medicaid reimbursement. • Reviews medical records for accuracy for QI, MDS, and PPS. • Review findings of state Medicaid reviews for accuracy. • Completes the nursing portion of the ADRs as specifically indicated by the state’s review of PPS. • Reviews all resident charts at each nursing facility monthly for any changes in resident conditionresulting in TILE, PPS and reimbursement changes, as well as changes in MDS and QI. • Provides in-services to licensed nursing staff regarding accurate and precise documentation of care provided to support PPS and TILE level. • Provides training to Directors of Nursing and nurse assessors regarding proper completion of 3652 forms and MDS. • Provides training to business office managers regarding tracking levels of care for both TILES and PPS. • Reviews all TILE level changes made by TDHS nurse reviewers – submits all required documentation to TDHS for those changes deemed inaccurate. • Reviews all PPS levels and IQ Indicators. • Reviews monthly resident status reports, ensures TILE levels listed on report are identical to TILE levels calculated from most recent 3652 form. • Determines reasons for any expired levels of care identified on monthly resident status report and reviews center tracking system to identify cause of expired levels. • Reviews electronically transmitted 3652 forms for accuracy providing training and assistance intransmitting forms as needed. • Reviews MDS and QI for accuracy and provides training and assistance in obtaining QI andsubmitting PPS. QUALIFICATIONS • Current nursing license in the state in which practicing. • Strong organizational and mathematical skills. • Strong verbal and written communication skills. • Previous experience in long-term resident care Medicaid reimbursement, PPS, MDS and QI.Experience as a Director of Nursing in long-term care preferred. ADMINISTRATIVE • Attends and participates in all assigned meetings, training, education and in-services as required. • Furnishes written reports identifying recommendations and observations in TILE levels, PPS, and concerns with QI and MDS at the conclusion of each center review to the Regional Vice President, QA, Director of Medicaid Reimbursement and the center’s Administrator and Director of Nurses. • Follows-up on previous month’s recommended TILE level, PPS, QI and MDS changes and identifies these changes on a written report. • Meets at lease monthly with the QA/Resource Team to review PPS control logs, Medicaid reports and QI. • Attends and participates in monthly meeting with Director of Medicaid Reimbursement. • Attends IDT, PPS “stand-up” meetings when in the centers. • Conducts exit interview with Administrator, Director of Nurses and MDS Coordinator to reviewcontents of report. OPCO Skilled Management provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type 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. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.