Clinical Reimbursement Coordinator /MDS Nurse at Clarksville

Focused Post Acute Care Partners•Mabry, TX

1d•Onsite

About The Position

The MDS Coordinator will assist the Director of Nursing with ensuring that documentation in the center meets federal, state, and certification guidelines. The MDS Coordinator will coordinate the RAI process assuring the timeliness and completeness of the MDS, CAAS, and Interdisciplinary Care Plans.

Requirements

Must have a current LVN license
Minimum of two (2) years nursing experience in skilled nursing facility preferred
Excellent knowledge of RAI Process, the federal Medicare PPS process, and Medicaid reimbursement as required
Thorough understanding of the Quality Indicator process
Knowledge of the OBRA regulations and Minimum Data Set
Knowledge of the care plan process

Responsibilities

To assure resident safety
Assist the facility in assuring adherence to federal and state regulations and certification
Actively participates in the regulatory or certification survey process and the correction of deficiencies
Report trends from completed audits to the Quality Assurance Committee
Assures the completion of the RAI Process from the MDS through the completion of the plan of care
Initiates and monitors RAI process tracking, discharge/re-entry, and Medicaid tracking forms through the AHT system
Follows up with staff when necessary to assure compliance to standards of documentation
Collect data for each resident and interview staff and residents as necessary to assure a good standard of practice and as instructed in the MDS 3.0 User manual
Facilitates accurate determination of the Assessment Reference Date that accurately reflects the patient's care needs and captures all resources utilized to ensure appropriate payment by Medicare/Medicaid and insurance programs
Provides an interdisciplinary schedule for all MDS assessments and care plans as required by OBRA and PPS
Assures appropriate signatures are obtained as required; maintains staff signature logs
Ensures that the interdisciplinary team makes decisions for either completing or not completing additional MDS assessments based on clinical criteria as identified in the RAI manual
Responds to change in conditions appropriately
Coordinates scheduling notice of patient care planning conference and assures communication of outcomes/problems to the responsible staff, patient, and/or responsible party
Ensures all MDS information and care delivered as outlined in the Care Plan is supported by documentation
Assist the Administrator/Director of Nursing with monitoring to ensure that a care plan is initiated on every patient upon admission to the center
Participates in the daily Interdisciplinary Team meeting and communicates needs for changes in PPS Timeliness and Assessment Reference Dates and deficiencies in completion of MDS, CAA, and Care Plan
Relays and/or acts upon information from the Clinical Reimbursement Specialist audits
Acts as a resource person for computer issues that relate to the MDS process; contacts the help desk when indicated.
Maintains proficiency in software programs
Responsible for ensuring appropriate Medicare coverage through regular communication with Clinical Reimbursement Specialist
Sequence appropriate diagnosis coding for residents
Corrects and ensures completion of final MDS and submits resident assessment data to the appropriate state and Federal government agencies in a timely manner
Assigns, assist, and instructs all staff in the RAI Process, PPS Medicare, Medicaid (Case Mix as required), and clinical computer system in relation to these processes
Ensures timely submission of the MDS to the state with proper follow up on validation errors; maintains validation records from the submission process in a systematic and orderly fashion
Maintains confidentiality of necessary information
Maintains assessment on the active clinical record for at least 15 months
Remains proactive with staying current on all industry changes
Assist with OTG reviews, ADR's, RAC audits, etc. as needed with professionalism
Coordinates monthly Triple Check meeting for Medical billing compliance
Completes LTCMI timely on TMHP portal and communicates with BOM regarding payer changes to ensure no loss in Medicaid payment
Utilize electronic medical record charting: point click care