Registered Nurse Assessment Coordinator (RNAC)

Rai Coordinator

The RAI Coordinator is responsible for the timely completion of all OBRA and Medicare assessments to comply with federal regulations. Oversees the overall process and tracking of Prospective Payment System (PPS) Minimum Data Set (MDS) assessments including completion, submission and correction as needed. Integrates nursing, dietitian, therapeutic recreation, restorative, rehabilitation, and physician services to ensure accurate assessments which capture all clinical conditions and provided services.

Confirms payer source of all residents per HIQA.

Ensures the accurate and timely completion of all MDS Assessments including OBRA and Medicare PPS.

Maintains an accurate schedule of all MDS assessments to include the proper reference dates throughout the resident's stay.

Responsible for electronic submission of all MDS assessments. Verifies electronic submission of MDS and performs corrections when necessary and maintains appropriate records.

Coordinates interdisciplinary participation in completing the MDS for each resident according to regulatory time frames. Ensures completeness of MDS and thoroughness of documentation as mandated by federal and state standards.

Schedules resident care conferences in compliance with state and federal regulations and ensures completion of all MDS reviews prior to resident care conference.

Assists disciplines with care planning process by ensuring the MDS information is completed timely, the Care Area Assessments (CAAs) are analyzed thoroughly, and the team has completed the MDS prior to care conference.

Ensures all Medicare documentation follows federal and state guidelines and is completed timely. This includes the physician certification/Recertification, Traditional Medicare and Medicare Advantage non-coverage letters for part A and B.

Monitors activities of daily living for accuracy and provides education when warranted.

Conducts daily PPS meeting, weekly Medicare/Insurance and Quarterly Clinical Review meetings.

Coordinates the monthly billing process including the triple check meeting, the attested billing report, and the HMO log. Assists with the appeal process to insure that timelines are met and appeals submitted.

Coordinates managed care process including submitting timely updates and obtaining ongoing authorizations. Ensures the timely completion of Medicaid Picture Date submissions.