Reimbursement Services Director jobs in Nashville, TN

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)

B
Director of Clinical Reimbursement
  • Brookdale Corporate - Nashville
  • Brentwood, TN FULL_TIME
  • Overview

    Voted by Newsweek in 2024 as one of America's Greatest Workplaces for Diversity      Make Lives Better Including Your Own. If you want to work in an environment where you can become your best possible self, join us!  You’ll earn more than a paycheck; you can find opportunities to grow your career through professional development, as well as ongoing programs catered to your overall health and wellness.  Full suite of health insurance, life insurance and retirement plans are available and vary by employment status.  Additional benefits offered include, but are not limited to:
    • Tuition Reimbursement
    • Pet Insurance
    • Adoption Reimbursement Benefits
    • Variety of Associate Discounts
     This is an incentive based position, which may include bonuses, incentive or commission plans. Veterans, transitioning active duty military personnel, and military spouses are encouraged to apply. Please note, Brookdale is committed to complying with all applicable laws and regulations regarding mandatory COVID-19 vaccination. To support our associates in their journey to become a U.S. citizen, Brookdale offers to advance fees for naturalization (Form N-400) application costs, up to $725, less applicable taxes and withholding, for qualified associates who have been with us for at least a year.

    Responsibilities

    The Director of Clinical Reimbursement is responsible for the oversight of Medicare/Medicaid/Managed Care reimbursement and regulatory issues. This will role will provide managerial support to our skilled nursing communities. 
  • Ensures that reimbursement structures are managed, evaluated, and capture accurate resource utilization at the facility level.
  • Responsible for the tracking, auditing, and analyzing of data for reimbursement and support of the coding of the MDS. 
  • Promotes the capturing of appropriate clinical reimbursement for services provided while ensuring the highest level of revenue integrity. 
  • Understands regulations, practice standards, and procedures, as well as laws and guidelines pertaining to the RAI process and payment methodologies for all payers, including, but not limited to CMS and PDPM. 
  • Oversees reporting systems to audit facility MDSs and determine modifications needed as appropriate, as well as providing education to the facility on the reasons for the necessary modification. 
  • Trains and educates the facility team as it relates to current state and federal regulations for reimbursement and payment models for both PDPM and state specific Medicaid models and CMI. 
  • Analyzes and reports the impact of federal and state Medicare/Medicaid regulatory changes and develop responses, as needed.
  • Conducts facility visits to support the teams in each facility, while providing a visit report to the regional team, operations, rehab, and the VP, Clinical Operations and Regulatory Compliance.
  • Partners with Operations, clinical and financial team members to develop and enhance clinical reimbursement tools and systems.
  • Completes monthly review/reporting of CASPER reports to audit RAI process and review QMs, as well as a monthly action plan for QMs related to 5-star rating system.
  • Continues an ongoing communication and collaboration with the regional and corporate teams. 
  •   This job description represents an overview of the responsibilities for the above referenced position.  It is not intended to represent a comprehensive list of responsibilities.  An associate should perform all duties as assigned by his/her supervisor.

    Qualifications

    Education and ExperienceBachelor’s Degree in Nursing with 8-10 years of healthcare related experience in care of the senior population required. Mush have experience as Regional Director of Reimbursement and expert level knowledge of RAI process and MDS 3.0.  Must have Minimum of 8 years of demonstrated leadership skills and competencies required.  Certifications, Licenses, and Other Special RequirementsActive RN License in good standing required. Certification as RAC-CT required.  Management/Decision MakingApplies existing guidelines and procedures to make varied decisions within a department. Uses sound judgment and experience to solve moderately complex problems based on precedent, example, reasonableness or a combination of these. Uses independent judgment to make decisions based on scope of nursing practice, safety, consideration for liability, and knowledge of the risk management processes.  Knowledge and SkillsPossesses extensive knowledge of a distinct skill or function and a thorough understanding of the organization and work environment. Has a working knowledge of a functional discipline. Extensive knowledge of the Resident Assessment Instrument (RAI) and MDS 3.0. Strong knowledge of case mix, therapy utilization, and restorative nursing.  Physical Demands and Working Conditions 
    • Standing
    • Walking
    • Sitting
    • Use hands and fingers to handle or feel
    • Reach with hands and arms
    • Climb or balance
    • Stoop, kneel, crouch, or crawl
    • Talk or hear
    • Ability to lift:  up to 25 pounds
    • Vision
    • Requires interaction with co-workers, residents or vendors
    • Occasional weekend, evening or night work if needed to ensure shift coverage
    • On-Call on an as needed basis
    • Requires Travel:  Occasionally 
    • Requires Driving:  Drives self (Tier 2)
     Brookdale is an equal opportunity employer and a drug-free workplace.
  • 8 Days Ago

B
Director of Clinical Reimbursement
  • Brookdale Corporate - Nashville
  • Brentwood, TN FULL_TIME
  • Overview Voted by Newsweek in 2024 as one of America's Greatest Workplaces for Diversity Make Lives Better Including Your Own. If you want to work in an environment where you can become your best poss...
  • 8 Days Ago

C
Regional Director of Clinical Reimbursement
  • ClearView Healthcare Management
  • Nashville, TN FULL_TIME
  • ClearView Healthcare Management is seeking a Regional Director of Clinical Reimbursement! As the Regional Director of Clinical Reimbursement, you will be a subject matter expert on Medicare/Medicaid r...
  • 9 Days Ago

V
Environmental Services Director
  • Vitality Senior Services
  • Franklin, TN FULL_TIME
  • Environmental Services Director Location: Franklin, TN, 37064 Skills Required: Leadership skills Flexibility to be on-call Job Description: The Environmental Services Director will be responsible for ...
  • 1 Month Ago

N
Director of Services
  • NHC Home Care
  • Franklin, TN FULL_TIME
  • Definition: A qualified HomeCare manager hired by the Vice President, HomeCare and approved by the governing body to administer, direct and coordinate the activities of the HomeCare agency’s branch of...
  • 11 Days Ago

B
Beverage Director-The Underground Cocktail Club Nashville
  • Beverage Director The Underground Cocktail Club Nashville
  • Nashville, TN FULL_TIME
  • Beverage Director-The Underground Cocktail Club Nashville The Underground Cocktail Club Is Coming to Nashville! This will be the first Underground Cocktail Club in Nashville, The Underground nightclub...
  • 9 Days Ago

Filters

Clear All

  • Filter Jobs by companies
  • More

0 Reimbursement Services Director jobs found in Nashville, TN area

U
Director of Partnerships
  • Urban Green Lab
  • Nashville, TN
  • **LINKEDIN APPLICATIONS WILL NOT BE ACCEPTED; FOLLOW SPECIFIC INSTRUCTIONS BELOW** Director of Partnerships for Urban Gr...
  • 4/26/2024 12:00:00 AM

C
Director of Operations
  • Ciresi & Morek
  • Nashville, TN
  • We are currently assisting our Tier 1 automotive customer with a Director of Operations search near Nashville, TN. This ...
  • 4/25/2024 12:00:00 AM

A
Director, Capture
  • Amentum
  • Nashville, TN
  • Job Description Amentum is seeking a full-time **Capture Manager** to lead and support growth in its Critical Missions/S...
  • 4/24/2024 12:00:00 AM

H
Director of Pediatrics
  • HCA
  • Nashville, TN
  • This position is incentive eligible. Introduction Managers thrive with us! HCA Healthcare is one of the nation's leading...
  • 4/24/2024 12:00:00 AM

C
Director of Operations
  • Ciresi & Morek
  • Nashville, TN
  • We are currently assisting our Tier 1 automotive customer with a Director of Operations search near Nashville, TN. This ...
  • 4/24/2024 12:00:00 AM

T
Director of Humanities
  • Taymax Group
  • Nashville, TN
  • POSITION: Director, HumanitiesLOCATION: DSST: Home OfficeSALARY RANGE: $95,000 - $106,400 with up to 6 years of aligned ...
  • 4/23/2024 12:00:00 AM

W
Clinical Resource Director Ambulatory Surgery
  • Work from Home
  • Nashville, TN
  • Description This position is incentive eligible. Introduction Do you want to join an organization that invests in you as...
  • 4/23/2024 12:00:00 AM

D
Director
  • Dismas Charities
  • Nashville, TN
  • JOIN DISMAS and work for one of the nation's largest not-for-profit providers specializing in community-based adult re-e...
  • 4/22/2024 12:00:00 AM

Nashville is the capital and most populous city of the U.S. state of Tennessee. The city is the county seat of Davidson County and is located on the Cumberland River. The city's population ranks 24th in the U.S. According to 2017 estimates from the U.S. Census Bureau, the total consolidated city-county population stood at 691,243. The "balance" population, which excludes semi-independent municipalities within Davidson County, was 667,560 in 2017. Located in northern Middle Tennessee, Nashville is the main core of the largest metropolitan area in Tennessee. The 2017 population of the entire 14-...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Reimbursement Services Director jobs
$141,888 to $202,051
Nashville, Tennessee area prices
were up 1.3% from a year ago

Reimbursement Services Director in Albuquerque, NM
The Manager will be responsible for either audit or reimbursement functions, and can be responsible for one of four primary roles – desk review/audit, reopenings/appeals, interim rate review/reimbursement or acceptance/finalization for all provider types as both a preparer and reviewer of work product.
December 27, 2019
Reimbursement Services Director in Little Rock, AR
The Manager assigns annual workload budget, distributes assignments to the team, ensures timely and accurate completion and review of all work, and makes final reimbursement determinations for all work assigned to the team.
February 24, 2020
Reimbursement Services Director in Las Vegas, NV
The Director of Reimbursement will consistently improve processes and develop their teams to exceed established KPIs and raise collection revenue, while lowering the overall cost to deliver these services.
January 05, 2020