Reimbursement Services Director directs and supervises the activities of the claims and provider reimbursement personnel. Handles third-party reimbursement for services rendered to patients. Being a Reimbursement Services Director sets procedures for filing reimbursement claims and ensures timely and accurate claims payments. Monitors, evaluates and reviews all cost reporting in support of reimbursement claims. Additionally, Reimbursement Services Director develops policies and procedures compliant with fiscal and regulatory requirements. Oversees the collection of statistical and financial data needed for preparing annual and monthly health insurance reports. May require an advanced degree. Typically reports to top management. The Reimbursement Services Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Reimbursement Services Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
ESSENTIAL FUNCTIONS OF POSITION:
- Plans and directs a comprehensive social services program which provides support services for residents and family.
- Responsible for coordinating all admissions and discharge to ensure facility census is kept at its maximum capacity.
- Participates in an interdisciplinary team approach to better serve the needs of the facility population.
- Provides for therapeutic intervention to help residents cope with the social and psychological aspects of their illnesses, impairments, or disabilities as well as their feelings about separation from family/community, physical and emotional loss.
- Maintains written documentation in the customer medical record per facility policy and state federal guidelines.
- Performs an initial evaluation/assessment of each resident’s biopsychosocial needs to be placed in medical records. Active cases require ongoing written documentation.
- Develops social services component of the resident’s plan of care identifying specific problems, goals and approaches. Ensures and documents that resident/families have input into the care planning process.
- Acts as a liaison/advocate between residents, families, outside agencies, and the Administrator to ensure that the residents rights are maintained.
- Takes responsibility for conducting family group meetings as needed (new admissions group, support group, family and friends’ council, etc)
- Performs administrative requirements such as completing necessary forms and reports under the direction of the Administrator and submitting such reports to the Administrator and/or consultants as required.
- Facilitates discharge planning including the development of an organized discharge plan.
- Participated in departmental budget planning and supplies monthly report to Administrator.
- Performs additional duties as assigned.
EDUCATION/ REQUIREMENTS
Must possess as a minimum, a bachelor’s degree in Social Work or a a bachelor’s degree in a human services plus a minimum of two years’ experience in a supervisory capacity in a Long Term Care; or equivalent combination of education and experience. Must possess any certification/ licensures required by State regulations.
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