Manager, Clinical Reimbursement, Long Term Care (LTC)

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. 

Work Shift:

8 Hours - Day Shifts (United States of America)

Scheduled Weekly Hours:

40

Salary Range: $40.00 - $66.00

Union Position:

No

Department Details

Option to work remote or in office. Flexible work schedule available. Occasional travel including AAPACN conference, team retreat, and regional meetings.

RN required, BSN preferred. RAC-CT required.

Opening due to internal promotion.

Reports directly to Chief Nursing Officer.

Summary

Develop processes and procedures to assure the appropriate and maximum reimbursement is received for the services provided in the long-term care facilities. Responsible to remain current on existing and new Medicare/Medicaid reimbursement regulations and develop processes to provide education as reimbursement methodologies changes. Provide leadership and direction to the team and work with leadership at the enterprise level and the facilities level.

Job Description

Define and implement the protocol for the reimbursement projects that come in through the compliance hot line. Evaluate the current reimbursement systems/tools/reports and develop education training tools as changes occur. Responsible to ensure systems, processes and procedures are established to effectively manage reimbursement for Skilled Nursing Facility Medicaid, Medicare, and managed care programs relating to MDS, documentation, and Assessment Reference Dates. Develop and direct the training for staff on the Minimum Data Set (MDS) resident evaluation completion and coding of medical condition, appropriate usage of ARD's, and activities of daily living. Developing and/or enhancing reimbursement reports and tools to track PDPM and CMI distribution.

Provides direction on Assessment Reference Date (ARD) process for assigned centers to ensure we are setting the ARD to maximize revenues and submit MDS timely, as applicable to State reimbursement and payer. Work closely with IT, therapy, nursing, and quality teams to ensure all training and support provided is aligned. Assure our priorities are aligned with executive leadership. Responsible to set processes, procedures, and expectations associated with expected reimbursement outcomes. Utilizes Care Watch and Point Click Care reports and any other available tools/reports for accuracy of MDS coding, benchmarks, gaps and potential related reimbursement opportunities. Develops work plans with locations to implement appropriate practices/processes to maximize reimbursement. Partner with Quality team to monitor and validate quality measures report for accuracy of MDS coding.

Other work duties as assigned.

Qualifications

Sanford is an EEO/AA Employer M/F/Disability/Vet. 

If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org.