- Perform independent and/or suggested affiliate level, clinical and
financial audits as warranted. - Identify and assist with educational
opportunities through audit, tracking, trending, and analyzing relevant
patient data with supervisor guidance and support. - Strategic planning
as relates to ARDs to optimize appropriate revenue systems. - Ensure IDT
compliance with state/federal requirements and timeframes related to
MDS, billing and care planning. - Provide high level interpretation of
revenue related data as requested. - Identify revenue related risks
associated with missing, irrelevant, erroneous clinical documentation.
Assist with action plans related to such risk. - Assist with orientation
and education for CRCs and other IDT members as relates to MDS and/or
reimbursement processes. - Provide ongoing education and communication
with IDT as relates to current state and federal regulation systems
driven by the MDS. - Review clinical charts to determine skilled need
and assist with determining appropriate Length of Stay. - Attest to
completion of MDS at section Z. Sign MDS completion for any LPNs in the
department. - Develop and revise care plans as per facility protocol.
Attend/Lead CP meetings per facility protocol. - Conduct daily, weekly,
monthly meetings related to Revenue. (Daily REV, Wkly MRA/CMI, Monthly
Triple check) - Ensure the timeliness of managed care updates. - Assist
with maintenance, risk and education related to 5 STAR Quality
Measures/Value Based Purchasing, and Quality Reporting programs. -
Provide information as requested for Additional Documentation Request
(ADR). - Other related duties as assigned. Qualifications: - MA licensed
nurse with 3+ years reimbursement or similar experience in the LTC
industry. - Computer literacy (Word, Excel, Power Point, Outlook). -
Experience with current EMR (NTT) software a plus. - Evidence of
effective written, verbal, and technological communication. -
Demonstrates excellent organization, communication, and presentation
skills. - Deadline driven, detail-oriented individual with strong
analytical capabilities. - Working knowledge of state and federal
regulations governing the MDS and billing processes within a nursing
facility. (CMI/PDPM/Managed care, QRP/VBP) - Ability to communicate with
and elicit support from other IDT members at the affiliate level. -
Ability to apply knowledge in state specific Medicaid and Medicare
CMI/PDPM methodologies. - Exhibits independent and self-directed work
ethic. - Must exhibit excellent interpersonal relations, time
management, family and customer relations and job knowledge. - Must be
able to read, write, speak, and understand the English language.
Education - Graduate of accredited RN Program required. Salary starting
at \$45.00 per hour Qualifications Education Required Associates or
better in Nursing or related field. Experience Preferred 1 year: Do you
have Clinical Reimbursement Coordination experience? Licenses &
Certifications Preferred REGISTERED NURSE