MDS Coordinator

Friendly Senior Living•Rochester, NY

1d•$33 - $42•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. This role is responsible for evaluating and determining Medicare and continued Medicare coverage for both new admissions and readmissions, utilizing current criteria. The specialist identifies and assures the availability of supporting documentation that will maximize reimbursement from both internal and external sources. They coordinate and communicate pertinent information to Nursing and Therapy to maximize reimbursement, and review all Medicare A and Medicaid MDS's 3.0 for content accuracy and appropriate RUGS’s codes prior to submission. The position also tracks new admissions eligible for Medicare but without skilled needs for the first thirty days to identify possible eligibility, and communicates to Nurse Managers when a Member is Medicare covered and why to ensure necessary supporting documentation. Additionally, the specialist assists in educating Friendly Home employees regarding the reimbursement system, investigates and corrects findings by the Medicare consultant, and stays abreast of changes in the RUGS and Medicare reimbursement systems. They serve as a Clinical Liaison for HMO’s and assist with the management of the Medicaid only case mix. The role tracks therapy minutes to comply with Medicare guidelines, communicates and sets up appropriate MDS’s, and communicates to the finance department. They also communicate to HMO’s/Medicare Advantage to ensure documentation and updates are completed, manage all appeals for Medicare A & B, and provide training to new staff on MDS completion in Health MedX. The specialist obtains all authorization numbers for Medicare B Members for skilled therapy, demonstrates excellent communication skills, and provides training to nurses and CNA’s on ADL coding. Compliance with HIPPA regulations is required. The role may be required to perform other duties as assigned. In conjunction with the Director of Health Services, the specialist reviews and updates documentation systems for PDPM.

Requirements

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.
Must be able to perform essential job functions (reasonable accommodation may be apply).

Nice To Haves

R.N./B.S.N. preferred.

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.