The Senior Regional Director of Clinical Reimbursement provides services in accordance with company policies, federal and state guidelines to maintain the Resident Assessment Instrument (RAI) process within LCS communities. The Senior Director of Clinical Reimbursement has the primary responsibility of managing the processes and associates within the Clinical Reimbursement Department of LCS. The Senior Director of Clinical Reimbursement role is responsible for developing education, compliance monitoring and directing quality through monitoring of the resident assessment process of of LCS..

 

Experience is Everything:

At LCS, experience is everything. We provide you the opportunity to use your talents in a progressive, growing organization that makes a positive difference in the lives of the seniors we serve. If you are seeking an organization that gives back, you’ll love working here. Our principles and hospitality promise define our company culture. LCS employees can be found participating in volunteer activities, getting involved in our committees or collaborating with team members in our innovative workspace. You’ll find several opportunities to grow as a professional, serve the community, and enhance the lives of the seniors. 

 

The Role: 

Leads the Clinical Reimbursement Team through development of education and processes to achieve the organizational desired outcomes.  Identifies and monitors the clinical reimbursement benchmarks to measure LCS clinical reimbursement success Active participant in the interview and selection of MDS Coordinators within the direct aligned communities and across the organization as indicated Collaborates with LCS Financial Department Leaders to identify processes, benchmarks and communication of LCS Clinical Reimbursement Department Routinely monitors compliance of LCS established benchmarks and RAI Manual guidance Provides consistent RAI education and support to LCS MDS Coordinators Maintains communication with Regional Directors of Clinical Reimbursement and MDS Coordinators for the purpose of anticipating needs. Performs audits of RAI process to assess compliance of timeliness and accuracy Provides action plan development and monitoring assistance of action plans based on data trends or survey outcomes Develops, educates and monitors compliance of the LCS policies, procedures and practices associated with the RAI process. Monitors submission and outcome of external audits of Medicare and like Additional Documentation Request (ARDs), appeals and denials Establishes community support cadence to monitor performance, assessment compliance, clinical documentation quality and the RAI process Monitors LCS organizational quality measure trends and participates in the development of action plans to impact continuous improved quality of care Utilizes corporate key trend reports to monitor the oversight of clinical quality and reimbursement outcomes Supports collaboration of the LCS Therapy Partners to establish programs and innovation Monitors LCS data to determine case mix, Medicare, and managed care reimbursement trends to identify LCS program development Lead the development of clinical education and training programs Develops processes for best practices of the admission, daily clinical review, weekly Medicare review, and triple check processes of LCS Organization Provides MDS guidance and support as requested of LCS community leadership Maintains extensive knowledge of the Resident Assessment Instrument (RAI), the MDS process, the Care Area Assessments (CAA), and the care planning process Develops and participates in training programs for LCS Community Leaders Supports compliance of resident assessment and care plan process in accordance with state and federal guidelines

Experience and Qualifications: 

BSN Must possess at least five years of previous MDS Coordinator experience  Must possess at least five years of previous MDS Coordinator experience. Must understand the philosophy and principles of the RAI process Must possess a RAC-CT Certification from the American Association of Nurse Assessment Coordination (AANAC) or be willing to earn Three years of regional multi-site experience required Medicare audit, appeals, and denial experience required.

 

Knowledge and skills:

Maintains the ability to quickly adapt and respond to internal challenges through assessment and solution orientated processes Maintains knowledge of the full continuum of care, the Resident Assessment Instrument, the interdisciplinary care plan process, the Minimum Data Set, related regulations and reimbursement guidelines. Knowledge to develop, implement education to determine the skilled level of services provided are appropriate for the evaluation and treatment of a disease, condition, illness, or injury, consistent with the applicable standard of care Knowledge to formulate and educate a comprehensive process to provide a written response for appeals, ensuring that necessary information is presented effectively Maintains knowledge of and adheres to the requirements of HIPAA Knowledge to develop LCS Clinical Reimbursement benchmarks and analyze data for organizational trends Demonstrates the ability to write clear quantifiable reports that will serve as clear action plans associates and community leaders Maintains superior skills in communication, both verbally and written Manages multiple priorities with the skill to prioritize competing tasks Must be fiscally responsible with company and community finances. Develops accurate and validated expense reports, per company policy Highly motivated, self-initiator displays the ability to work independently with a minimum amount of supervision. Requires the use of good judgment and common sense in the performance of duties. Must be able to evaluate and respond to the Clinical Reimbursement Department Team and community requests

 

Why LCS? 

Industry leader. The Nation’s third-largest senior living operator ranked number one in customer satisfaction among senior living communities. 

 

Inclusive and collaborative culture. We’re dedicated to diversity, equity, and inclusion and have an engaged Diversity and Inclusion Council focused on creating awareness and educating employees on inclusivity. In addition, LCS creates a collaborative culture that provides an exceptional experience for every employee. 

 

Top Workplace USA: LCS has earned the 2024 Top Workplaces USA award and is recognized for our strong company culture and engaged workforce. In addition, LCS earned ten culture excellence awards in areas such as DE&I practices, top managers, professional development, and clued-in leaders, to name a few.

 

Top Workplace Iowa: LCS employees truly believe we are an employer choice. This recognition, for 4 years running, is in large part due to the culture of excellence that our employees help deliver every single day.

 

Competitive pay, great benefits and vacation time.  We are an equal opportunity employer with benefits including medical, dental, life insurance, disability, 401(k) with company match and paid parental leave.

 

Charity and community involvement. We are recognized as a national team for the Alzheimer’s Association and consistently a top contributor to United Way. We also support our employee’s individual community contributions and provide opportunities to get involved at our corporate locations and in our communities.

 

Outstanding advancement opportunities. LCS is growing and we think you should too. Our company growth allows for internal growth opportunities across all of our business lines.

 

Ongoing career development. Onsite education opportunities, education assistance, and continuing education credits allow LCS employees to keep their knowledge of current industry changes relevant.

 

LCS creates living experiences that enhance the lives of seniors. You’ll see this commitment in our people. They’re talented, dedicated professionals who truly care about residents, with each conducting his or her work with integrity, honesty, and transparency according to the principles of LCS. We strive to help every community succeed—strengthening available resources, establishing proven practices that lead to long-term growth and creating lasting value for those living in, working for and affiliated with the community. Check us out on our website: www.lcsnet.com

 

Travel Frequency: 26-50%

Job Level: B

Estimated Salary Range: $128,000 - $160,000.

 

The actual title and salary offer will carefully consider a wide range of factors, including your skills, qualifications, experience, and other relevant factors.

 

A POST-OFFER BACKGROUND CHECK, INCLUDING REFERENCES, IS REQUIRED

LCS IS AN EQUAL OPPORTUNITY EMPLOYER