MDS Coordinator

Friendly Senior Living•Rochester, NY

21h•Onsite

About The Position

The Clinical Nurse Reimbursement Specialist organizes and directs the clinical reimbursement programs with the goal of maximizing reimbursement for The Friendly Home. We consider many different factors to determine your compensation package at FSL. We assess your specific job family, level, relevant skills, experience, and other special trainings, or accomplishments you bring to the position. Pay decisions are also guided by our financial means as well as analyzed against what others earn internally. We strive to pay competitively and offer market differentiated benefits and perquisites in line with our compensation philosophy. The salary range is a reflection of many similar like positions and your actual compensation may not be at the high or low end of the range but will be based on your unique skills and other criteria mentioned. FSL is committed to offering each individual an elevated employee experience through growth and learning opportunities in addition to an inclusive work culture coupled with other perquisites.

Requirements

R.N./B.S.N. preferred.
Experienced in Long Term Health Care, as well as current experience in MDS 3.0, RUGS reimbursement methodology, Medicare reimbursement regulations and prospective payment system.
Current New York State Registration and License.
Must meet the general health requirements set forth by Friendly Home.
May be requested to assist in the evacuation of Members or perform other procedures to protect the safety of Members, visitors and team members during emergency situations.

Responsibilities

Evaluates and determines Medicare and continued Medicare coverage for both new admissions and readmissions, utilizing current criteria.
Identifies and assures the availability of supporting documentation that will maximize reimbursement from both internal and external (hospitals, outpatient facilities, etc.) sources.
Coordinates and communicates pertinent information to Nursing and Therapy in order to maximize reimbursement.
Reviews all Medicare A MDS's 3.0 for content accuracy and appropriate RUGS’s codes prior to submission.
Reviews all Medicaid MDS’s 3.0 for appropriate and accurate documentation prior to submission.
Tracks new admissions that are technically eligible for Medicare, but do not have skilled needs for the first thirty days following admission, to identify possible eligibility.
Communicates to Nurse Managers when a Member is Medicare covered and why to ensure necessary supporting documentation.
Assists in the education of Friendly Home employees regarding the reimbursement system.
Responsible to investigate and correct findings by the Medicare consultant.
Stays abreast of changes in the RUGS and Medicare reimbursement systems.
Serves as Clinical Liaison for HMO’s.
in conjunction with Nursing and Therapy, assists with the management of the Medicaid only case mix.
Tracks therapy minutes to comply with Medicare guidelines communicate and set up appropriate MDS’s and communicate to finance department.
Communicate to HMO’s/Medicare Advantage ensures that documentation and updates are completed.
Manages all appeals for Medicare A & B.
Provides training to new staff on MDS completion in Health MedX.
Obtains all authorization numbers for Medicare B Members for skilled therapy.
Demonstrates excellent communication skills.
Provides training to nurses and CNA’s on ADL coding.
Complies with HIPPA regulations.
May be required to perform other duties as assigned.
In conjunction with Director of Health Services reviews and updates documentation systems for PDPM.