Corporate Clinical Reimbursement Manager

Presbyterian Senior Living is a mission-driven organization that lives our values of integrity, mutual respect, creative curiosity and connectedness in all that we do. Our legacy of serving more than 6,000 older adults with respect and dignity for over 95 years supports our mission to promote wholeness of body, mind and spirit for all that live within our communities.

The Corporate Clinical Reimbursement Manager is responsible for establishing and supporting clinical documentation systems related to MDS documentation, value-based reimbursement payment models and staff scheduling systems. This position reviews community clinical information processes, documentation, and consults with Executive Directors/Health Care Administrators and community staff as required. This position is also required to participate in projects requiring integration with vendors, information technology teams, clinical and financial teams. 

Qualifications:

• Registered Nurse with a Bachelor’s degree in Nursing required
• Minimum of 3 years’ experience in the MDS process, quality improvement, and clinical documentation systems required
• Demonstrated ability to manage projects and priorities
• Strong technical expertise and knowledge of clinical health technologies
• Demonstrated ability to interact with all categories of staff and stake holders of a multi-community organization; includes: Trustees, staff, resident regulators, residents, family members, surveyors and other health care providers
• Ability to travel to PSL communities/locations and partner sites required
• Current and valid driver’s license required 

Expectations:

• Monitors all Clinical Documentation systems and works with community and corporate staff to assure that documentation supports the billing and reimbursement received. 
• Responsible for the accurate and timely communication of issues with the clinical reimbursement process.
• Develops paper clinical documentation which assures regulatory and reimbursement compliance  and provides efficient and effective use of PSL resources.
• Responsible for the implementation and education of the clinical documentation and all processes to support reimbursement as it relates to the Patient Driven Payment Model (PDPM) or any other future models. 
• Knowledge of Quality Measures and Five Star Rating system.
• Knowledge of all clinical reimbursement billing processes for the organization.
• Monitors all clinical documentation systems and works with community and AO Staff to assure that all documentation is appropriate and supports the services provided.
• Responsible for the accurate and timely communication of issues with the clinical reimbursement process.
• Coordinates and conducts RNAC orientation/competencies as they relate to corporate process/performance.
• Plans, directs, coordinates, and assures electronic health records/clinical systems orientation education and on-going education for community directors including Executive Director, Administrator and RNAC.
• Jointly accountable with the VP of Technology and Assets to assure the appropriate electronic infrastructure for PSL communities to successfully implement the electronic health record.
• Consults, guides and educates PSL staff on all EHR documentation requirements to support clinical reimbursement in concert with the Vice President of Clinical Excellence and the VP of Compliance/Privacy Officer.
• Maximize use of technology to improve clinical reimbursement documentation. 
• Works cooperatively with the VP of Compliance/Privacy Officer in developing standards and audit systems.  
• Serves as a member of the compliance committee.
• Reports findings of site visits and assists communities with the development of plans for correction. 
• Consults with and guides staff regarding care planning processes.
• Works cooperatively with the Corporate Director of Compliance/Privacy Officer in developing, evaluating and amending policies and procedures for compliance.
• Responsible for the development, implementation and monitoring of PSL’s Restorative Nursing Program.
• Develops regulatory compliant coding standards in cooperation with the Medical Records staff within communities to ensure compliance with billing requirements.
• Responsible for Payroll Based Journal.
• Acts as system administrator for scheduling system.
• Participates/Leads assigned meetings.
• Represents PSL in related professional associations, trade associations and consortia.