MDS Coordinator RN

Balance Life & Work with a New Career Opportunity(SKILLED NURSING)(ASSISTED LIVING)Now Hiring - Clinical Reimbursement Coordinator - (Livingston, NJ)(CareOne at Livingston)The Clinical Reimbursement Coordinator assures the implementation of company policies and procedures pertaining to the Medicare and Managed care reimbursement in the facility. This position reports to the Administrator of the facility and receives consultative assistance from the Regional Clinical Reimbursement Specialist. The Clinical Reimbursement Coordinator is also responsible for regulatory compliance and quality improvement efforts in order to attain appropriate Medicare or Managed Care reimbursement. This position integrates information from all necessary disciplines to maintain accuracy and compliance with the MDS process. By conducting concurrent MDS reviews, he/she assures the achievement of maximum allowable RUG categories. Working collaboratively with facility team members, the CRC ensures that services offered meet or exceed federal, state and company standards and serves as a role model for ethical business practices according to health standards.Essential Duties and ResponsibilitiesMaintain a professional standard of behavior when interacting with staff, residents family members or visitorsFollow and uphold the company Code of ConductFacilitate Daily PPS and Weekly Medicare meetingKnowledge of and compliance with HIPAA guidelinesKnowledge of and ability to download reports from Point RightKnowledge of and ability to download state and federal reports from InternetParticipate in Monthly Billing Reconciliation meetingComplete MDS's per schedule as required for Medicare, Managed care and OBRA schedulesInitiate/Update Care plans as requiredEnsure compliance with State, Federal, and Point Right transmissions and make modifications as neededFacilitate and coordinate with other disciplines to maintain care plan development and ongoing updates per MDS scheduleProvide updates as required per Managed Care contract guidelinesCommunicate promptly with facility team/regional consultant any issues or concernsCompletion and issuance of denial letters, coordination of Medicare certification completion, review of skilled nursing documentation (including CNA documentation) to support skilled needsServe as the center resource for MDS/PPS; and state Medicaid reimbursement.Manage Medicare appeals process, and participate in Administrative Law Judge hearings as needed.Implement and participate in the company processes developed to appropriately maximize reimbursementPosition Requirements:Graduate of an approved RN programCurrent RN license in the state and credentials as requiredPrior experience in Medicare reimbursement and/or MDS experience preferredKnowledge of Managed Care reimbursement systemsWord processing and computer skillsExcellent oral and written communication skillsExcellent ability to maintain an effective, friendly working relationship with othersBasic mathematic ability; ability to use calculatorKnowledge of quality improvement process, how it affects the 5 Star report, and ability to identify issues or trends and implement corrective action plans as neededKnowledge of the 5 Star reportExcellent attention to detail; well organizedAbility to provide one-on-one or small group education related to identified areas of need

Created: 2024-11-02