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VP of Clinical Reimbursement in Chicago, IL at Generations Healthcare Network

Date Posted: 4/21/2018

Job Snapshot

Job Description

Generations Healthcare Network a post-acute and long term care consulting company is looking for a VP of Clinical Reimbursement.   The  RN,  VP  of Clinical Reimbursement must have an  expertise in MDS (Minimum Data Set) and Illinois Medicaid and Medicare case mix processes, and HFS and Medicare regulations. The RN, VP  of Clinical Reimbursement will be responsible for ongoing review and management of two reimbursement specialists and provides consultation to 11 skilled nursing facilities.


Responsibilities:


  • Manages  2 reimbursement specialists

  • Establishes in depth understanding of all clinical programs that impact reimbursement

  • Develops structures to optimize clinical service revenue in accordance with all rules/regulations that apply.

  • Establishes metrics and goals for process and outcome measures that impact on and result in reimbursement and provides guidance to client facilities

  • Trains facility personnel on all areas of reimbursement as well as restorative programing

  • Tracks reimbursement rates noting trends.

  • Responds to any audit for either Medicare and/or Medicaid and gathers necessary paperwork for submission

  • Responds to claim irregularities

  • Reviews all HFS data including client rosters for accuracy

  • Acts as an expert advisor on all areas of Medicare processes from eligibility to coverage to appeals

Job Requirements

  • RN licensed in Illinois required

  • RN licensed in Indiana would be a plus

  • Expertise with MDS preferred RAC-certified, ANCC certified

  • Must have relevant experience in post-acute/long term setting

  • Strong knowledge of reimbursement regulations