RNAC - MDS Coordinator
Company: Genesis Healthcare
Location: Woodbridge
Posted on: January 27, 2023
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Job Description:
POSITION SUMMARY: The Clinical Reimbursement Coordinator (RN)
manages the overall process and tracking of all Medicare/Medicaid
case-mix documents in order to assure appropriate reimbursement for
services provided within the Center. Conducts concurrent MDS
reviews to assure achievement of maximum allowable RUG categories.
He/she will integrate information from nursing, dietary, social
services, restorative, rehabilitation and physician services to
ensure appropriate reimbursement.
RESPONSIBILITIES/ACCOUNTABILITIES: 1. RevenueOptimization -
Resource Utilization: 1.1 Tracks Medicare Customers to determine
continued and appropriate Medicare eligibility and benefit period
by determining skilled level of need; 1.2 Prior to admission,
reviews pre-admission intake information with the External Care
Coordinator or Admissions Coordinator to estimate RUG levels for
Medicare Customers and to identify potential resource costs,
consider formularies, and communicate findings to
Administrator/care team; 1.3 Performs concurrent MDS review to
insure appropriate RUGs category is achieved through the capture of
appropriate clinical information. Identifies opportunities to
enhance reimbursement; 1.4 Directs the interdisciplinary team
process to communicate opportunities to ensure capturing of all
resources; 1.5 Collaborates with Reimbursement Services to review
RUG reports and identify RUG categorization. 2. MDS Schedule and
Tracking: 2.1 Maintains an accurate schedule of all MDS assessments
to include the proper reference dates throughout the Customer's
stay and ensures the accurate and timely submission of the MDS
assessments including case-mix, OBRA and OSRA required assessments;
2.2 Communicates to the Care Plan Coordinator the MDS assessment
schedule to ensure timely facilitation of the care planning
process. 2.3 Completes the admission and discharge tracking form
and maintains tracking system for admission/re-entry/discharge; 2.4
Manage the data entry function to ensure the accuracy of the MDS
and verify electronic transmissions to Genesis and the state. 3.
Billing: 3.1 Coordinate with the Center Business Office, and
or/Centralized Business Office when available throughout the month,
to communicate case-mix data required for billing such as RUGs
categories, modifiers, state case-mix scores, etc. 4. Education and
Resource: 4.1 Serves as the Center resource for MDS/RUGs and state
case-mix systems; 4.2 Provides case-mix education to the
interdisciplinary team as appropriate; 4.3 Instructs Center staff
in terminology, language, and format that is required by MDS; 4.4
Communicates with Center Administrator, interdisciplinary team and
Reimbursement Services regarding any changes in case-mix
regulations such as PPS and/or state specific case-mix systems; 4.5
Trains backup personnel for the Clinical Reimbursement Coordinator;
5. Other Duties 5.1 Assists in the preparation of all requests from
appropriate State and/or federal regulatory agencies or agents
regarding payment of services (reconsideration, denials appeals,
etc.); 5.2 Maintains all reports and transmission data in a
systematic format and stores in a safe, locked area; 5.3 Maintains
a current and comprehensive knowledge of MDS and Medicare/ Medicaid
reimbursement; 5.4 Implements all required forms, procedures and
processes relative to job responsibilities; 5.5 Performs other
related duties as requested. Compliance Responsibilities Complies
with applicable legal requirements, standards, policies and
procedures including but not limited to those within the Compliance
Process, Standard/Code of Conduct, Federal False Claims Act and
HIPAA. Participates in required orientation and training programs.
Promptly reports concerns and suspected incidences of
non-compliance to supervisor, Compliance Liaison or to the
Compliance Officer via the Integrity Hotline. Cooperates with
monitoring and audit functions and investigations. Participates, as
requested, in quality assurance and process improvement activities.
BenefitsHealth, Dental, Vision, Company-paid life insurance, 401K,
Paid Time Off *Variable compensation plansInclusive workplace with
DEI committeeNursing Student Loan Debt Repayment and Tuition
AssistanceTuition, Travel, and Wireless Service DiscountsEmployee
Assistance Program to support mental healthEmployee Foundation to
financially assist through unforeseen hardships Restrictions apply
based on collective bargaining agreements, applicable state law and
factors such as pay classification (full-time, part-time, or
casual), job grade, location, and length of service.
CCRNQualifications:SPECIFIC EDUCATIONAL/VOCATIONAL REQUIREMENTS: 1.
Graduate of an accredited School of Nursing with current RN
licensure in the state in which employment occurs is required. 2.
One year of long term care clinical nursing experience is required.
3. Experience with Medicare/Medicaid reimbursement, MDS completion,
clinical resource utilization and/or case management is highly
desirable. 4. Experience with basic computer technology. 5. This
position requires that the employee is able to read, write, speak
and understand the spoken English language to ensure the safety and
wellbeing of our patients and visitors at the work site when
responding to their medical and physical needs. 6. Maintains
current BLS/CPR certification (excluding ALFs/ILFs). 7. To protect
the health and safety of our patients, residents, employees, family
members, and the communities we serve, Genesis has implemented a
universal COVID-19 vaccination requirement for employees, care
partners and onsite vendors.Other Info
Keywords: Genesis Healthcare, New England , RNAC - MDS Coordinator, Other , Woodbridge, Northeast
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