Regional Director of Clinical Reimbursement
Full Time
San Antonio, TX 78209
Posted
Job description
** This role will support our South Region (9 communities) - Corpus Christi and Rio Grande Valley areas
Join our family. Make a meaningful difference. Join The Team and our Mission to Serve Others
Touchstone Communities is committed to bringing best-in-class care to the patients, residents and Veterans we serve. Our purpose is to glorify God by serving others through compassionate, skilled care. Our dedicated team members are key to our success in providing positive healthcare experiences.
Touchstone Communities is seeking professionals who share our mission to improve the lives of those we serve every day. If you are driven by the desire to help, heal and empathize in a work environment where every voice matters, we encourage you to apply today!
The Purpose:
To coordinate and guide the delivery of premier resident centered health care to optimize profitability and a positive market presence through the coordination and implementation of clinical, regulatory and reimbursement systems so the region’s financial and clinical objectives are met or exceeded.
Essential Job Functions:
1. Observe and facilitate the QOL, Q-Mix and Triple Check meetings conducted in the communities once quarterly.
2. Review, support, mentor and guide the community MDS nurse on systems, nursing standards and guidelines.
3. Provides information and education to community and regional team members on use of the RAI / PPS / VA processes and their correlation to resident care and reimbursement.
4. Review and support the billing schedules and procedures.
5. Educate MDS Nurse and team members on the review process and provide recommendations to address potential areas of concern/opportunity, utilizing programs and reports on various state and company generated reports, such as:
- State Missing Assessment Report
- State Validation report
- Community Casper Report – QM’s
- 5 Star
- Point Right - FastTrack, RADAR, DIA, etc.
- Simple LTC/TMHP/Optima
- On-hold report
6. Provides expertise and guidance to MDS nurse and IDT members to ensure MDS accuracy and adherence to company policy and procedures and state/federal regulations and guidelines.
7. Provide education to MDS nurse and CNA’s on POC documentation, standard and change of condition alerts; late and mid-loss ADL’s to support MDS and QM data elements.
8. Review financial and clinical reports to identify trends and areas for improvement, to ensure an appropriate action plan is developed and implemented.
9. Work with the community to establish and update an OIG binder and assist the community during OIG reviews and reconsideration process.
10. Participates in clinical assignments for comprehensive reviews as part of the IDT regional team.
11. Community visits:
- Entry meeting – discuss purpose of visit and ask Administrator, MDS Nurse and DON areas they would like reviewed during visit
- Exit daily with Administrator, MDS nurse and DON to discuss findings
- Final exit – Discuss and provide final consultant visit report at the exit and obtain signatures.
12. Conduct audits of each communities EHR/documentation systems to include but not limited to:
o PCC MDS Module – Assessment Scheduler, ARD planner, 3.0 Batch and validation reports
o Assessment type, submission and timing of LTCMIs, PPS and OBRA assessments
o MDS item set components such as: risk management, physician’s orders, interviews, section GG, POC for ADL late and mid-loss ADL accuracy
o Significant Change Analysis Report/24 hour Summary – run report for 72 hour period X2 to obtain a 6 day look back and review for anything that flags impacting care plans and potential significant change MDS’s
o Physician Orders, Physician certifications/recertification’s
o Clinical Dashboard review –care plan reviews, incomplete (overdue and due) care plans, diagnosis notifications, change in condition alerts and point of care completion
o Baseline Care Plans – Initiated within 48 hours and reviewed/signed by RN
o UDA’s - for potential MDS opportunities
13. Interview applicants for community MDS nurse positions and provides recommendations to the hiring authority.
14. Participates in the on boarding process for orientation for new community MDS nurses and interdisciplinary team members.
15. Participates in all training as required including Relias, PCC, Point Right, SimpleLTC/TMHP, Optima and company program rollouts.
16. Provides information to regional operations, clinical and community management team on the status of clinical and financial reimbursement.
STANDARDS:
Position-Specific:
1. Communities’ 5 Star Rating Quality Measure rating will be at 4 Star or higher.
2. Review and audit resident assessments for timeliness and supporting of EHR resident information
3. Monitors and analyzes reports and identifies trends to implement programs and processes to improve outcomes
4. Makes recommendations for community MDS/IDT resources to optimize quality and financial outcomes
5. Implements and monitors RAI processes for regulatory compliance
Qualifications:
- A current and valid Texas RN nursing license or current enrollment in an RN program
- Familiar with Reimbursement system of Medicare, Medicaid & Case Management
- Skilled Nursing Facility Experience as an MDS Nurse
- RAC-CT or CMAC certification (preferred)
- Knowledge of state and federal regulations, both clinical and financial as it relates to the RAI process and reimbursement systems
- In-depth knowledge of the clinical software billing system and the MDS process.
- Proficient in the use of computer systems (WORD, Excel, EHR system, etc.)
- Ability to travel 80-100% of the time
Benefits:
We offer eligible team members an attractive benefit package that includes medical, dental, wellbeing, and vision benefits, along with other unique benefits including:
- Health Savings Allowance option for certain medical plans
- Paid Time Off; Bereavement Pay and Jury Duty Pay
- Tuition Reimbursement Program
- Matching 401(k) matching
- OnShift Wallet- access to your earned money before payday
- Life and Supplemental Insurance
- Mileage reimbursement (designated team members)
- Cell phone allowance (designated team members)
- Equity Plan for designated team members
- Legal benefits and will preparation
- Team Chaplain availability
EOE STATEMENT
We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.
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