MDS Coordinator RN

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ASSISTED LIVING)

Now Hiring - Clinical Reimbursement Coordinator - (Livingston, NJ)

CareOne at Livingston)

The Clinical Reimbursement Coordinator assures the implementation of company policies and procedures pertaining to the Medicare and Managed care reimbursement in the facility.

This position reports to the Administrator of the facility and receives consultative assistance from the Regional Clinical Reimbursement Specialist.

The Clinical Reimbursement Coordinator is also responsible for regulatory compliance and quality improvement efforts in order to attain appropriate Medicare or Managed Care reimbursement.

This position integrates information from all necessary disciplines to maintain accuracy and compliance with the MDS process.

By conducting concurrent MDS reviews, he / she assures the achievement of maximum allowable RUG categories. Working collaboratively with facility team members, the CRC ensures that services offered meet or exceed federal, state and company standards and serves as a role model for ethical business practices according to health standards.

Essential Duties and Responsibilities

Maintain a professional standard of behavior when interacting with staff, residents family members or visitors

Follow and uphold the company Code of Conduct

Facilitate Daily PPS and Weekly Medicare meeting

Knowledge of and compliance with HIPAA guidelines

Knowledge of and ability to download reports from Point Right

Knowledge of and ability to download state and federal reports from Internet

Participate in Monthly Billing Reconciliation meeting

Complete MDS's per schedule as required for Medicare, Managed care and OBRA schedules

Initiate / Update Care plans as required

Ensure compliance with State, Federal, and Point Right transmissions and make modifications as needed

Facilitate and coordinate with other disciplines to maintain care plan development and ongoing updates per MDS schedule

Provide updates as required per Managed Care contract guidelines

Communicate promptly with facility team / regional consultant any issues or concerns

Completion and issuance of denial letters, coordination of Medicare certification completion, review of skilled nursing documentation (including CNA documentation) to support skilled needs

Serve as the center resource for MDS / PPS; and state Medicaid reimbursement.

Manage Medicare appeals process, and participate in Administrative Law Judge hearings as needed.

Implement and participate in the company processes developed to appropriately maximize reimbursement

Position Requirements :

Graduate of an approved RN program

Current RN license in the state and credentials as required

Prior experience in Medicare reimbursement and / or MDS experience preferred

Knowledge of Managed Care reimbursement systems

Word processing and computer skills

Excellent oral and written communication skills

Excellent ability to maintain an effective, friendly working relationship with others

Basic mathematic ability; ability to use calculator

Knowledge of quality improvement process, how it affects the 5 Star report, and ability to identify issues or trends and implement corrective action plans as needed

Knowledge of the 5 Star report

Excellent attention to detail; well organized

Ability to provide one-on-one or small group education related to identified areas of need