Director of Reimbursement Programs at Creative Solutions in Healthcare

Fort Worth, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

22 Jul, 26

Salary

0.0

Posted On

23 Apr, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

MDS Accuracy, Clinical Reimbursement, RAI Guidelines, Nursing Home Regulations, Documentation Review, Leadership, Management, Compliance, Respiratory Evaluations, IV Infusion Documentation, PCC Alerts, Staff Education, Quality Care, Federal Regulations, State Regulations

Industry

Hospitals and Health Care

Description

DIRECTOR OF REIMBURSEMENT PROGRAMS ---------------------------------------- Join Our Team as a Director of Reimbursement Programs Ensure Accuracy. Maximize Compliance. Support Quality Care. We’re seeking an experienced and detail-oriented Director of Reimbursement Programs to join our corporate team. This position plays a critical role in reviewing documentation, ensuring MDS accuracy, and supporting facilities in capturing appropriate services for maximum reimbursement. The ideal candidate has strong leadership skills, deep knowledge of nursing home regulations, and a passion for ensuring compliance and quality care. ---------------------------------------- YOUR IMPACT AS A DIRECTOR OF REIMBURSEMENT PROGRAMS In this role, you will: * Review IV infusion documentation daily to ensure compliance with RAI guidelines and confirm MDS scheduling aligns with provided services. * Review Respiratory Evaluations (ACPlus and Respiratory Assessment UDAs) to ensure documentation accuracy and timely MDS scheduling. * Monitor PCC alerts daily to follow up on potential IV or respiratory therapy referrals. * Review Glide dismissed alerts and ensure all necessary follow-ups are completed. * Analyze Glide “Nursing Splits” for COPD with shortness of breath while lying flat, providing education to facilities when documentation is incomplete. * Collaborate with facility leadership to ensure reimbursement practices are aligned with company policies and federal/state regulations. * Provide education and support to facility teams to strengthen compliance and documentation processes. ---------------------------------------- WHAT MAKES YOU A GREAT FIT We’re looking for someone who: * Holds a vocational or advanced degree in nursing. * Has a solid base knowledge of clinical reimbursement and MDS practices. * Demonstrates significant leadership and management skills. * Possesses working knowledge of nursing home and payor MDS regulations. * Can perform duties within the outlined physical demands. * Shows genuine care and interest in serving elderly and disabled individuals. * Understands and complies with the Patient Bill of Rights and Employee Responsibilities. ---------------------------------------- BENEFITS (FULL-TIME) * Comprehensive Coverage: Health, Dental, and Vision Insurance * Extra Protection: AD&D, Short-Term Disability, Cancer, Critical Illness, and more * Life Insurance: Whole and Term Policies * Professional Growth: Tuition Reimbursement for continued education * Time to Recharge: Paid Time Off * Retirement Planning: Immediate 401(k) eligibility * Unwavering Support: Exceptional corporate resources and leadership ---------------------------------------- Reporting Structure This position reports directly to the Vice President of Clinical Reimbursement. ---------------------------------------- Equal Opportunity Employer We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Responsibilities

The Director of Reimbursement Programs is responsible for reviewing clinical documentation to ensure MDS accuracy and compliance with federal and state regulations. They also provide education and support to facility teams to optimize reimbursement practices and quality of care.