Director of Clinical Reimbursement Services

At FutureCare our Director of Clinical Reimbursement Services provides support to facility staff on clinical reimbursement issues relating to accurate MDS completion, utilization of Medicare/PPS reimbursement systems, RAI Manuals, OBRA Guidelines and PDPM Groupers. As part of our interdisciplinary team of nurses, the Director of Clinical Reimbursement Services provide clinical documentation for all assigned facilities, and they ensure timely completion of monthly billing for Maryland Medicaid.

Voted 12 years in a row in The Baltimore Sun as “Top Workplaces” and recognized in US Newsweek as “Best Nursing Homes”, FutureCare stands out as a leader in managing health care across a continuum of care. We are known for recognizing hard work and dedication and reward our team members for their compassion and care.  We also offer a Competitive Salary, Excellent Benefits Package, Nurse Retention Bonus, Flex/Advance Pay, Tuition Reimbursement, Career Growth Ladder, Employee Referral Bonus Program, Employee Assistance. and a matching 401K Plan. 

$7,500 Sign-On Bonus

• Lead and direct the completion of the resident assessment and schedules the care planning process in accordance with Federal and State guidelines for a resident within FutureCare’s adult/geriatric population
• Weekly visits to assigned facilities to provide day-day support to staff with MDS/RAI process and PDPM/PPS reimbursement systems
• Perform weekly audits of facility and staff performance and communicate findings to facility Administrator
• Participate in candidate selection for assigned facilities, training, and evaluation of MDS/PPS Coordinators
• Prepare and present both formal and informal facility-based educational programs and/or in-house training to strengthen staff performance
• Assures accuracy and completeness of entire residents’ medical record
• Manages the completion of MDS to ensure they are within HCFA and Medicare guidelines
• Facilitate MDS electronic submission to occur per State regulations
• Lead family/resident care plan conferences
• Make recommendations for policies, procedures, and practice with scope of work
• Communicate Medicare PPS billing information and Maryland Medicaid billing information to FutureCare’s billing department to ensure proper billing on a monthly basis
• with other departments as it relates to medical record documentation
• Retrieve various reports such as; (QI-Quality Indication/QM-Quality Measure, RUG Transmitted, MR etc.), for review by authorized FutureCare staff and as requested for regulatory agencies required by law
• Educates nursing staff on documentation requirements for reimbursement
• Lead interdisciplinary team meetings, triple check, QA, and PPS

• Must possess a valid RN license in good standing according to Maryland State and Federal requirements
• Extensive MDS 3.0 training and software experience required
• 3+ years’ experience as an MDS/PPS Coordinator
• Up to date knowledge of MDS/RAI process
• Up to date knowledge of MC/PPS reimbursement systems and Maryland Medicaid Billing Process Enteral Feeding Billing Process
• Progressive nursing experience preferably in a resident assessment environment
• Must possess managerial and interpersonal skills
• Computer literate with knowledge of clinical and other commonly used software
• Ability to communicate effectively with other team members
• In-depth experience and knowledge with PDPM and CMI as related to Medicare and Medicaid service reimbursements