Director of Clinical Reimbursement (RN)

Elderwood Administrative Services is seeking a highly skilled and experienced Director of Clinical Reimbursement (RN) to lead our clinical reimbursement team and ensure optimal outcomes through the accurate completion of the Minimum Data Set (MDS) process. This leadership role is essential for managing reimbursement in accordance with federal and state regulations, ensuring the financial health of the organization, and maintaining the highest level of resident care.

Established in 1978, Elderwood has grown to become the largest network of rehabilitation, skilled nursing, assisted living and independent living communities in Western New York, with over 50 facilities and nearly 5,000 employees. Elderwood is well known to, and highly regarded by the communities that each location serves. 

Director of Clinical Reimbursement (RN):

• The Director of Clinical Reimbursement ensures adherence to all federal Medicare and Medicaid regulations and provides education and support to facilities related to all CMS guidelines set forth.  This individual is responsible for auditing, analyzing and reporting on current Medicare and Medicaid census and collaborating with facility staff and administration to identify revenue opportunities.  This individual will also provide ongoing training to staff as related to Part A and B services, be largely involved with the billing department and month end claims process, responsible for annual Federal Final Rule review and MedPAC update and review.

 Our Compensation and Full Benefit Package includes:

• Buffalo downtown location with free & convenient parking
• Competitive wage and opportunities for advancement
• Medical, Dental, Vision Insurance
• Life insurance
• 401(k) with matching
• Paid Holidays
• Generous Paid Time Off

Director of Clinical Reimbursement (RN):

1. Travels as required to various facilities to provide support and education.
2. Conducts auditing of Medicare and Medicaid census and MDS data.
3. Provides ongoing education, support and training related to Medicare and Medicaid guidelines and regulatory updates as needed to all locations as assigned.
4. Participates in departmental discussions relative to Part A and B services and reimbursement.
5. Participates in ongoing CMS webinars and educational trainings.
6. Is a subject matter expert in their field; remains up to date on regulatory changes and best practices and communicates/educates as necessary.
7. Performs data analysis, reports on outcomes and provides updates routinely relative to organizational Part A and B metrics.
8. Works closely with other Clinical Reimbursement team members.

Director of Clinical Reimbursement (RN) - Skills/Competencies:

• Ability to work autonomously as well as in teams
• Effective problem-solving and decision-making skills
• Strong interpersonal and relationship development skills
• Exceptional communication skills both verbal and written
• Strong presentation skills
• Exceptional customer service skills
• Displays high attention to detail and meeting deadlines
• Displays flexibility for scheduling and travel
• Ability to multi-task and prioritize
• Displays team-focused demeanor and attitude
• Is self-directed, demonstrates initiative and accountability
• Ability to handle sensitive, confidential information and maintain privacy

Director of Clinical Reimbursement:

• Credentials as a Registered Nurse with a current state license in good standing in state in which work is performed
• Minimum of five (5) years of understanding and experience with:
  • MDS; specifically, PPS and CMI experience
  • Medicare Reimbursement including PDPM payment model
  • CMS Quality reporting
  • ICD-10 knowledge
  • Medicare, Medicaid and Managed Care reimbursement
• Proficiency with electronic health record applications/platforms; PointClickCare preferred 
• Proficiency with Microsoft Office and online conferencing platforms
• Current, valid driver license
• RAC-CT certification preferred