Reimbursement Specialist - Healthcare jobs in Knoxville, TN

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 matter expert on Medicare/Medicaid reimbursement and regulatory issues and provide managerial support to our TN skilled nursing facilities by performing the following responsibilities:

• Lead Projects (Medicare/Medicaid/MDS 3.0, EMR, etc.)
• Research complex reimbursement and regulatory issues and provide analyses/summaries.
• Provide education to other regional personnel and facility personnel on Medicare/Medicaid/MDS/Restorative/EMR regulatory issues.
• Prepare and deliver formal technical presentations as needed to internal and external groups.
• Analyze and report the impact of federal and state Medicare/Medicaid regulatory changes and develop responses if needed.
• Responsible for partnering with clinical and financial team members to develop and enhance clinical reimbursement tools and systems.
• Ensure that reimbursement structures are managed, evaluated and capture accurate resource utilization at the facility level.

Qualifications:

• Licensed Registered Nurse in State of TN.
• At least 3 years of MDS experience in long term care preferred.
• Extensive experience in Medicare, PPS and TN state reimbursement systems.
• Knowledge of the Resident Assessment Instrument (RAI) needed.
• Strong knowledge of case mix, therapy utilization and restorative nursing.
• Experience in adult training and education.
• Minimal travel but occasional overnights may be expected.

Benefits: Health, dental, vision and life insurance

EQUAL OPPORTUNITY EMPLOYER

The Facility is an equal opportunity employer. The Facility does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Facility will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Facility including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.