MDS Coordinator

Position Summary The Clinical Nurse Reimbursement Specialist organizes and directs the clinical reimbursement programs with the goal of maximizing reimbursement for The Friendly Home. Essential Job Functions 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. Other Job Functions Expectations of the Position Dependable, report to work on-time for every schedule shift (ready to work at beginning - start of shift) and work full schedule shifts unless physically unable or pre-approved Paid Time Off (PTO) which includes personal and vacation. Willing and able to work as required by the position and/or approved by management. Have reliable transportation to and from work. Must be clean and neat in appearance and have a "friendly" service-oriented personality. Abide by work-related / job procedures and organization policies; (refer to the Employee Handbook). Qualifications of the Position Education: R.N./B.S.N. preferred. Experience: 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. Skills: Licenses / Certifications: Current New York State Registration and License. Conditions of Employment Work is performed in a clean, well lit, "Home-Like," nursing Home setting. Employee must be able to perform essential job functions (reasonable accommodation may apply). Physical Requirements Refer to Physical Requirements form. 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. #J-18808-Ljbffr