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)
Job Purpose:
To act as a liaison and representative of the residents’ social interests and to plan, organize, develop and direct the overall operation of the Social Services Department in accordance with current federal, state and local standards governing the facility, and as may be directed by the Administrator, to ensure that the medically-related emotional and social needs of the residents are met and maintained on an individual basis.
Essential job Duties and Responsibilities:
Administrative Function:
Plan, develop, organize, implement, evaluate, supervise and direct social services programs and activities; ensure an ongoing quality assurance program and develop and implement appropriate plans of action to correct deficiencies; consult with and coordinate social services activities with administration, medical and nursing services, consultants and other related departments and implement changes as required; ensure that necessary forms, reports and progress notes are properly completed and contain informative descriptions of the services provided and the residents’ responses to the services; participate in community planning, development and implementation of social care plans, resident assessments and discharge planning to meet the needs of the facility, the residents and their families; coordinate social services programs with the residents and their families, staff members and community agencies through interviews, consultations and direct involvement in the programs; and provide information to residents and their families concerning available support agencies and financial assistance programs to meet the needs of the residents.
Quality Assurance Function:
Develop a preliminary and comprehensive assessment and written care plan that identifies the emotional and social problems and/or needs of the resident and the goals to be accomplished for each problem and/or need identified; encourage residents to participate in the development and review of care plans; ensure that all care plans are used in providing daily social services to the resident; participate in assessing, reviewing and revising care plans as required, at least quarterly; in ensure that quality control measures are continually maintained.
Compliance Function:
Participate in surveys conducted by authorized inspection agencies. Ensure ongoing Company compliance with all laws and regulations; ensure that the Company meets or exceeds accreditation standards; and implement “best practices” in all departmental activities.
Staff Development Function:
Maintain professional competence through participation in continuing education programs, seminars and training programs; attend and participate in leadership outside training programs; and attend and participate in Hazardous Communication and Universal Precautions training programs prior to reporting for work assignments.
Planning and Inventory Functions:
Recommend to the Administrator the equipment and supply needs of the Social Services Department; assist in the ordering and purchase of inventory; monitor adequate and cost effective inventory control procedures. Make periodic inspections of supplies and equipment to ensure that adequate levels are maintained and that equipment is available and working properly; and forecast needs of the department, prepare and plan the Social Services Department’s budget for equipment, supplies and labor, and submit to the Administrator.
Other Job Functions:
Resident Rights Function:
Maintain resident confidentiality; treat residents with kindness, dignity and respect; know and comply with residents’ Rights rules; monitor social services to assist in ensuring that all personnel are knowledgeable concerning residents’ emotional and social needs; review and promptly report to the Administrator and maintaining written records of all resident complaints and grievances.
Meeting and Committee Function:
Participate in all meetings and committees as requested.
Other Duties:
Other duties as assigned
Qualifications:
Must be a Licensed Social Worker in good standing.
Completion of secondary education at an approved school of Social Work. Previous experience in supervisory capacity preferred.
Must be able to relate positively and favorably to residents and families and to work cooperatively with other associates.
Must be capable of maintaining regular attendance.
Must be capable of performing the Essential Job Functions of this job, with or without reasonable accommodation.
Related experience at a level necessary to accomplish the job. Patience, tact, enthusiasm and positive attitude toward the elderly.
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