The Royal Health Group ensures the “Royal Standard of Excellence” in everything we do, a philosophy that extends not only to our residents, but to our employees as well. Founded in 1997 by James Mamary, Sr., the Mamary family owns and operates eight skilled nursing facilities, one assisted living facility and one home care operation, all offering innovative health care, superior service, and peace of mind to short and long term residents and their families. When you make the Royal Health Group your next career move, you’re not joining a company where you are just another employee; you become a member of the family.

Royal Health Group is Hiring Full Time Experienced Clinical Reimbursement Director on the South Shore and Upper Cape Cod Areas.

Job Description
The Clinical Reimbursement Director is responsible to oversee  the "Resident Assessment Instrument" process to ensure accurate and timely completion of resident assessments in accordance with Medicare, Medicaid, OBRA and other payor program requirements for eight facilities.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
 

• Manages Medicare Part A certification process.
• Performs ongoing audits to ensure an appropriate reimbursement level for each resident. Evaluates care to ensure that services and products match benefits available
• Reviews medical records, care plans, charting to ensure documentation supports care provided and reimbursement level.
• Monitors facility practice to ensure compliance with guidelines for participation in Medicare, Medicaid and other benefit programs. Initiates action needed to ensure compliance.
• Participates in triple check prior to release of claims. Tracks and reviews all claim denials to identify problems.
• Prepares and timely submits any additional development requests, reconsideration and administrative law judge hearings.
• Review state MDS validation reports to identify issues and or processes to ensure accuracy of submitted MDS’s.
• Responsible for evaluating and providing education, intervention and support for Medicare, PPS, RAI, state specific and special contract reimbursement.
• Oversee  the overall process of reimbursement for facilities.
• Audit  Medicare/Medicaid case-mix documents in order to assure appropriate reimbursement for services provided within the facility.

• Participates in the pre-admission process to ensure essential information needed for MDS/Case mix optimization is obtained from the referral source.
• Works in collaboration with Rehab Program Coordinator to ensure the most appropriate assessment reference date is utilized for assessments.
• Performs modifications of assessments in accordance with CMS Correction Policy.
• Other duties as assigned

Job Requirement
 

• Licensed Occupational Therapist, Physical Therapist, Licensed Practical Nurse, or Registered Nurse  in the Commonwealth of Massachusetts with strong clinical expertise
• 3 years of Clinical Reimbursement experience at the Regional level strongly preferred
• Matrix experience preferred
• Excellent customer service skills; dedication and commitment to providing excellent healthcare services to our residents, patients and family members
• Excellent ability to operate effectively and efficiently in an enthusiastic, team-oriented work environment
• Ability to artfully and factually develop and implement care plans, and communicate said care plans to appropriate parties
• comprehensive knowledge of Medicare and Medicaid reimbursement
• Ability to quickly recognize and identify symptoms and make decisions based on changes in acuity level
• Exceptional organization skills and detail-oriented

Royal Benefits:
Excellent Work Environment
Dental, Health and Vision Benefits
Paid Sick, Vacation and Holiday Time
401K - Life Insurance
Short and Long Term Disability Leave  
Competitive Pay
Career Advancement Opportunity

About Us:
The Royal Health Group is a family-owned company offering innovative healthcare and senior living at our eight skilled nursing facilities south of Boston and our welcoming assisted living community in Harwich on Cape Cod. All of our properties are TJC (The Joint commission, formerly JCAHO) accredited, a rating given to only the best nursing homes in the country. We pledge to maintain the "Royal Standard of Excellence" in everything we do, from long term skilled nursing and superb short term rehabilitation, to our "Royal Innovation" series of specialty services in Alzheimer's care, diabetes management, cardiac care, nutrition, and more. When you make the Royal Health Group your next career move, you're not joining a company where you are just another employee; you become a member of the family. Royal Health Group is an equal opportunity employer.