Regional Manager- Clinical Reimbursement (MDS)

Ensure Benedictine communities have clinical reimbursement processes and applications available to ensure accurate reimbursement based on CMS, state-specific private insurer processes, and for retrospective clinical reimbursement audits; proactively develop, educate, and implement community level and system-wide changes needed to meet new requirements as regulations and requirements change.

Develop and evaluate organization-wide policies, resources, and practices to ensure compliance with regulations for resident assessment instruments and reimbursement systems.
• Assist in development of systems to assess and improve the accuracy of clinical documentation in all care settings for subsequent payment, for implementation at the communities, and for utilizing an interdisciplinary approach. These systems may be federal (Medicare), individual state level (Medicaid), local, private and/or state insurance/managed plans, and new reimbursement requirements as developed by payer sources.
• Ensure implementation of policies and practices related to governmental payments systems such as Value Based Purchasing (VBP) and, Quality Reporting program (QRP).
• Provide clinical information, direction, consultation, and education/training to support clinical reimbursement in Benedictine SNF locations.
• Promote the achievement of Benedictine strategies by ensuring consistent utilization of clinical information systems and skills that integrate with regulatory compliance and clinical reimbursement.
• Guides the development and management of reimbursement related documentation to assist in completing MDS documentation to assure appropriate levels of clinical reimbursement.
• Promotes the Benedictine Mission and Core Values of Hospitality, Stewardship, Respect and Justice by bringing the Mission and Core Values into the day-to-day activities of the company.

QUALIFICATIONS REQUIRED

• Three (3) or more years of leadership experience in senior care reimbursement
• Registered Nurse License
• BLS Certification

EEO/AA/Vet Friendly

A robust benefits package is available to eligible associates, designed to meet the needs of every stage of life, including paid time off (PTO), retirement, medical, dental, vision, education assistance, and a variety of additional voluntary benefits. For more information visit our website at www.benedictineliving.org.