[itroundtable] LEAD: Director of Clinical Reimbursement- NJ

 

Please reply to Jack directly.   From Ann Bergquist http://www.linkedin.com/in/annbergquist   Can you recommend anyone for this Non-IT position. My Bergen County, NJ client is looking for a Director of Clinical Reimbursement- This person will assure the management of the Medicare, Managed Care and Medicaid reimbursement system for a number of skilled nursing facilities; Will be responsible for regulatory compliance and quality improvement efforts, in order to attain the appropriate Medicaid/Medicare reimbursement possible for the facilities; ensure that the services offered exceed standards. To $120,000. Position Summary: The Regional Director of Clinical Reimbursement assures the management of the Medicare, Managed Care and Medicaid reimbursement system for a region-specific number of skilled nursing facilities. In this role you will be responsible for regulatory compliance and quality improvement efforts, in order to attain the appropriate Medicaid/Medicare reimbursement possible for assigned facilities.  You will ensure that the services offered exceed federal, state, and company standards, and serve as a role model for ethical business practices according to standards. You will have 3 direct reports that assist with the oversight of Clinical Reimbursement.    Essential Duties and Responsibilities: 1.) Systems implementation and assessment ·         Implement and direct Medicare and Medicaid auditing and systems review. ·         Admission pre-screening review ·         Admission documentation requirement review ·         Financial documentation requirement review ·         Clinical documentation assessment ·         Strategic selection of assessment reference dates ·         MDS accuracy ·         ADL score tracking ·         Denials management ·         RUGs management 2.) Education and Training ·         Provide Interdisciplinary Team Training ·         MDS and PPS training ·         Documentation requirements ·         RUGs groups ·         Admission strategies ·         Role and responsibility of the Clinical Reimbursement Coordinator ·         NJ Case mix ·         Managed Care contracts and updates ·         HIPPS coding ·         Consolidated billing ·         Update facilities on trends, developments, concepts and techniques in the Medicaid and Medicare fields that affect reimbursement services ·         Engage facility management team in problem solving process to identify improvement opportunities and achieve solution ·         Facilitate effective well-organized utilization meetings, establish productive objectives and follow through with action plans ·         Evaluate performance of facility-based staff and make recommendations regarding staff assignments, assessment procedure and reimbursement systems.  Ongoing evaluation of the effectiveness of reimbursement staff ·         Fee schedules ·         Industry updates and regulation changes 3.) Revenue Management ·         Financial Analysis ·         Rate projections ·         Vendor contract strategies ·         Monthly RUGs distribution ·         Length of stay analysis ·         Assist in Part B program development ·         Assist in budget process. 4.) Overall Responsibilities: ·         Management of Regional Clinical Reimbursement Specialists ·         Education and Training ·         Medicare and Medicaid updates ·         Analysis trends ·         General oversight Recommended Qualifications:  Diploma and/or Degree from credentialed school of nursing.  Currently licensed as a Registered Nurse in the state of practice. ·         Minimum of 5 years of experience in long term care. ·         Proven knowledge of quality improvement processes with an emphasis on Medicare, Managed Care and NJ Case mix for Skilled Nursing facilities. ·         Multi facility experience with management skills ·         Excellent oral and written communication skills. ·         Work processing and related computer skills. ·         Current licensing and credentials as required. --------------------------------------------------------------------------------------------------------------------------------------------------------------- Jack M Schwartz Managing Director ITech Recruiting LLC 516-826-4640 office 516-524-6010 cell jackschwartz@itechrecruiting.com  -------------------------------------------------------------------------------------------------------------------------------------------------------------- JACK SCHWARTZ is the Managing Director of Staffing at ITech Recruiting LLC.  Previously, he was a V.P., Staffing Services at The Ayers Group, and he ran the NYC  I.T. Contingency Search Practice for The Jarvis Walker Group (JWG). Before JWG, Jack was the CIO of the NPD Group, a market research firm. Prior to NPD, he managed three metropolitan area offices for Source EDP, a national IT search firm, and was a Senior Director of Applications Development for the Federal Reserve Bank of New York. Jack has a BS and an MS in Engineering from Cornell University and an MBA in Finance from the Stern School of Business of N.Y.U.

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