Reimbursement Services Director jobs in Tennessee

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.
  • 6 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...
  • 6 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...
  • 7 Days Ago

C
Regional Director of Clinical Reimbursement
  • ClearView Healthcare Management
  • Knoxville, TN FULL_TIME
  • ClearView Healthcare Management is seeking a Regional Director of Clinical Reimbursement! Eastern and Central Tennessee area! As the Regional Director of Clinical Reimbursement, you will be a subject ...
  • 8 Days Ago

C
Regional Reimbursement Specialist (Regional MDS Director)
  • Champion Care
  • Memphis, TN FULL_TIME
  • Due to our recent growth we are currently interviewing for a Regional Reimbursement Specialist to add to our team in Tennessee! At Champion Care, we are driven by a noble mission: to deliver unparalle...
  • Just Posted

T
Admin Director Surgical Services
  • Texas Nursing Services
  • Chattanooga, TN FULL_TIME
  • Administrative Director Surgical Services Opportunity in Chattanooga, TN💰 Annual Salary: $140,000 - $180,440🌍 Location: Chattanooga, TN📅 Schedule: Full-Time, No Weekends🌟 Bonus Incentives: 15-22.5...
  • Just Posted

S
Director, Clinic
  • Sanford Health
  • Alexandria, MN
  • Careers With Purpose Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the Unite...
  • 4/25/2024 12:00:00 AM

B
Project Director
  • BluSky
  • Minnetonka, MN
  • BRIEF DESCRIPTION: The construction Project Director is responsible for managing and closing new business opportunities ...
  • 4/23/2024 12:00:00 AM

B
Project Director
  • BluSky
  • Boston Metro, MA
  • BRIEF DESCRIPTION: The construction Project Director is responsible for managing and closing new business opportunities ...
  • 4/23/2024 12:00:00 AM

U
Director of Operations
  • Uncommon Schools
  • Camden, NJ
  • Company Description Uncommon Schools is a nonprofit network of high-performing, public charter schools providing an outs...
  • 4/22/2024 12:00:00 AM

B
Project Director
  • BluSky
  • Orlando, FL
  • BRIEF DESCRIPTION: This is a highly compensated position with commission potential Base Salary Range is $70,000 - $100,0...
  • 4/22/2024 12:00:00 AM

U
Director of Operations
  • UHC Solutions
  • Los Angeles, CA
  • The Director of Clinic Operations is responsible for the overall planning, development, coordination, implementation and...
  • 4/21/2024 12:00:00 AM

W
Director of Preconstruction
  • Wallick Communities
  • New Albany, OH
  • Description Wallick’s Construction team is currently seeking an experienced Construction professional for a Director of ...
  • 4/3/2024 12:00:00 AM

L
Executive Director
  • Life Space Communities
  • Amarillo, TX
  • Community: The Craig Address: 5500 SW 9th Ave Amarillo, Texas 79106 Pay Range $139,900. 00-$202,912. 50+ Annual Live you...
  • 9/22/2023 12:00:00 AM

Tennessee borders eight other states: Kentucky and Virginia to the north; North Carolina to the east; Georgia, Alabama, and Mississippi on the south; Arkansas and Missouri on the Mississippi River to the west. Tennessee is tied with Missouri as the state bordering the most other states. The state is trisected by the Tennessee River. The highest point in the state is Clingmans Dome at 6,643 feet (2,025 m). Clingmans Dome, which lies on Tennessee's eastern border, is the highest point on the Appalachian Trail, and is the third highest peak in the United States east of the Mississippi River. The ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Reimbursement Services Director jobs
$139,478 to $198,619

Reimbursement Services Director in Huntington, NY
Mediware’s reimbursement team provides trusted home infusion and DME reimbursement services including complete outsourced billing and collections, consulting, due diligence services, and flexible collection project options.
February 13, 2020
Reimbursement Services Director in Salem, OR
Tuition Reimbursement Services, or Programs, are also referred to as Tuition Assistance Programs.
February 18, 2020
Reimbursement Services Director in Queens Village, NY
Manages the team member’s and workload of the Audit/Reimbursement unit to ensure compliance with the standards set forth by the Centers for Medicare and Medicaid Services (CMS).
December 17, 2019