Director of Clinical Reimbursement

Director of Clinical Reimursement

Job Summary

The Corporate Clinical Reimbursement Director will oversee multiple facilities under Ryders Health Management and is responsible for establishing and supporting clinical documentation systems related to MDS documentation, value-based reimbursement payment models, and staff scheduling systems.

Company Description

Ryders Health Management is a family-owned long term care provider enteraing our 75th anniversary. We operate 8 skilled nursing facilities across Connecticut, two of which were recently named among the Best Nursing Homes in America for 2025 by Newsweek, one being #1 in Connecticut.

We offer excellent benefits, including 401K matching, company-paid life insurance and a caring community that reflects a great deal of longevity among our staff. Join our dynamic team today!

Director of Reimbursement | Key Responsibilities

• This position reviews the facility clinical information process, and documentation and consults with Administrators and facility staff as required
• This position also requires you to participate in projects requiring integration with vendors, information technology teams, clinical and financial teams
• Monitors all Clinical Documentation systems and works with facility and corporate staff to ensure that documentation supports the billing and reimbursement received
• Responsible for the accurate and timely communication of issues with the clinical reimbursement process
• Develop clinical documentation that assures regulatory and reimbursement compliance and provides efficient and effective use of Company resources
• Responsible for the implementation and education of 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 facility leadership and Staff to ensure that all documentation is appropriate and supports the services provided
• Responsible for the accurate and timely communication of issues with the clinical reimbursement process with the Corporate Clinical Director and Finance Director.

Director of Reimbursement | Additional Responsibilities

• 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 ongoing education for Administrator and RNAC
• Jointly accountable with the Director of IT to ensure the appropriate electronic infrastructure for facilities to implement the electronic health record successfully
• Consults, guides, and educates staff on all EHR documentation requirements to support clinical reimbursement in concert with the Corporate Clinical Director.
• Provide quarterly reports to the Corporate Clinical Director.
• Maximize the use of technology to improve clinical reimbursement documentation
• Works cooperatively with the Compliance/Privacy Officer in developing standards and audit systems
• Serves as a member of the compliance committee
• Reports on findings of site visits and assisting communities with the development of plans for correction
• Consult with and guide staff regarding care planning processes
• Works cooperatively with the Corporate Clinical Director in developing, evaluating, and amending policies and procedures for compliance
• Responsible for the development, implementation, and monitoring Restorative Nursing Program
• Develops regulatory-compliant coding standards in cooperation with the Medical Records staff within communities to ensure compliance with billing requirements
• Participators/Leads assigned meetings

Qualifications

• A Registered Nurse License is 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 stakeholders of a multi-facility organization, including Trustees, staff, resident regulators, residents, family members, surveyors, and other healthcare providers
• Ability to travel to locations and partner sites as required
• Current and valid driver’s license required

Full-Time Benefits:

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