MDS/Clinical Reimbursement, RN

Covenant Living•Northbrook, IL

11d•$42 - $54

About The Position

The MDS Clinical Reimbursement, RN, is a vital member of the healthcare team responsible for ensuring accurate and timely reimbursement for the services provided by the organization. This role requires a strong understanding of medical coding, billing practices, and healthcare regulations. This role works with the interdisciplinary team (nursing, therapy, dietary, social services, activities) to complete MDS assessments, analyze care areas, and develop and revise a comprehensive care plan to ensure that compliance is maintained with state and federal guidelines. This position is responsible for attesting to the completion of the Minimum Data Set (MDS) which is the key driver of the care plan, quality measures and used for Medicare payment and many Medicaid reimbursement systems. This role serves as the expert resource for the Patient-Driven Payment Model (PDPM) and is responsible for complying with ethical and timeliness standards when setting ARDs, completing assessments and upholding Medicare requirements. ESSENTIAL RESPONSIBILITIES: Coordinate the RAI process including MDS, Care Area Assessment process, Care plan development, Care plan implementation and Evaluation as prescribed by State and Federal regulations. Be knowledgeable of federal regulations, practice standards, procedures as well as guidelines pertaining to the RAI process. Provide oversight of assessment completion and transmission to the national repository. Review final validation reports and correct or modify assessment in response to warnings or errors as needed. Maintain the OBRA and PPS assessment schedules. Be highly involved in determining the skill level of care for Medicare residents and procuring required Medicare-specific documentation; be responsible for physician certification/recertification of a skilled level of care throughout the Medicare stay; be involved in making Medicare eligibility determinations. Coordinate care with Case managers for residents utilizing managed care, health maintenance organizations (HMOs) commercial insurance and other alternate payment models. Provide insight and analysis of MDS-based Quality Measures. Serve as a member of the quality assessment and assurance (QAA) and or quality assurance and performance improvement committees (QAPI). Work closely with hospital discharge planner and physician to obtain accurate and complete documentation to support ICD-10- CM diagnosis coding and surgical procedures. Participate in discharge planning, training, caregiver training and the provision of resources as needed. Foster effective working relationships and build consensus. Maintain confidentiality of sensitive information. Plan, organization, prioritize, and work independently to meet deadlines. Use judgement and make sound independent decisions. Work effectively with individuals at all levels of the organization, as well as residents, family members, visitors, government personnel and the public.

Requirements

Associate’s Degree in Nursing, RAC CT Certification or RAC CTA Certification
2+ Years Experience
Have knowledge of current state and federal regulations, particularly the following pertinent sections of Appendix PP: - 483.20 Resident Assessments - 483.21 Comprehensive Resident-Centered Care Plans
Knowledge of medical terminology to ensure correct coding and billing processes.
The ability to comply with ethical and timeliness standards when setting ARDs, completing assessments, and upholding Medicare requirements.
Integrity, attention to detail, accuracy, time-management skills, ability to meet deadlines, critical thinking skills, written and verbal communication skills, care plan development skills and problem-solving skills
Ability to stand, sit, talk, reach, stoop, kneel, and use hands and fingers to operate a computer, telephone, and keyboard.
Ability to lift, carry, push, and/or pull light to moderate amounts of weight up to 100 lbs.
Ability to operate various equipment base on department.
The ability to hear, understand, and distinguish speech and/or other sounds (e.g., machinery alarms, medical codes or alarms. Four hearing requirements listed: In person speech, Telephone, Other remote speech and other sounds.
Clarity of Vision: For near visual acuity Clarity of vision at approximately 20 inches or less (i.e., working with small objects or reading small print), including use of computers.
For far visual acuity, Clarity of vision at 20 feet or more. This is not just the ability to see a person or object, but the ability to recognize features as well.
For peripheral vision, observing an area that can be seen up and down or to right or left while eyes are fixed on a given point.

Nice To Haves

Bachelor’s Degree in Nursing
ICD-10 Certification Course
RN License and CPR, if required by state

Responsibilities

Coordinate the RAI process including MDS, Care Area Assessment process, Care plan development, Care plan implementation and Evaluation as prescribed by State and Federal regulations.
Be knowledgeable of federal regulations, practice standards, procedures as well as guidelines pertaining to the RAI process.
Provide oversight of assessment completion and transmission to the national repository.
Review final validation reports and correct or modify assessment in response to warnings or errors as needed.
Maintain the OBRA and PPS assessment schedules.
Be highly involved in determining the skill level of care for Medicare residents and procuring required Medicare-specific documentation; be responsible for physician certification/recertification of a skilled level of care throughout the Medicare stay; be involved in making Medicare eligibility determinations.
Coordinate care with Case managers for residents utilizing managed care, health maintenance organizations (HMOs) commercial insurance and other alternate payment models.
Provide insight and analysis of MDS-based Quality Measures.
Serve as a member of the quality assessment and assurance (QAA) and or quality assurance and performance improvement committees (QAPI).
Work closely with hospital discharge planner and physician to obtain accurate and complete documentation to support ICD-10- CM diagnosis coding and surgical procedures.
Participate in discharge planning, training, caregiver training and the provision of resources as needed.
Foster effective working relationships and build consensus.
Maintain confidentiality of sensitive information.
Plan, organization, prioritize, and work independently to meet deadlines.
Use judgement and make sound independent decisions.
Work effectively with individuals at all levels of the organization, as well as residents, family members, visitors, government personnel and the public.