Regional Clinical Reimbursement Systems Manager

Job description

Overview 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. Responsibilities: - 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 cl...