Clinical Reimbursement Specialist LVN

JOB TITLE:  MDS COORDINATOR – RN/LVN

REPORTS TO:  DIRECTOR OF NURSING

POSITION SUMMARY:

The MDS Coordinator will assist the Director of Nursing with ensuring that documentation in the center meets federal, state and certification guidelines. The MDS Coordinator will coordinate the RAI process assuring the timelines and completeness of the MDS, CAAS and Interdisciplinary Care Plans.

QUALIFICATIONS:

· Must have a current RN/LVN license

· Minimum of two (2) years nursing experience in skilled nursing facility preferred

· Excellent knowledge of RAI Process, the federal Medicare PPS process and Medicaid reimbursement as required

· Thorough understanding of the Quality Indicator process

· Knowledge of the OBRA regulations and Minimum Data Set

· Knowledge of the care plan process
 

ESSENTIAL FUNCTIONS:
 

· To assure resident safety

· Assist the facility in assuring adherence to federal and state regulations and certification

· Actively participates in the regulatory or certification survey process and the correction of deficiencies

· Report trends from completed audits to the Quality Assurance Committee

· Assures the completion of the RAI Process from the MDS through the completion of the plan of care

· Initiates and monitors RAI process tracking, discharge/re-entry and Medicaid tracking forms through the AHT system

· Follows up with staff when necessary to assure compliance to standards of documentation

· Collect data for each resident and interviews staff and residents as necessary to assure good standard of practice and as instructed in the MDS 3.0 User manual

· Facilitates accurate determination of the Assessment Reference Date that accurately reflects the patient's care needs and captures all resources utilized to ensure appropriate payment by Medicare/Medicaid and insurance programs

· Provides interdisciplinary schedule for all MDS assessments and care plans as required by OBRA and PPS

· Assures appropriate signatures are obtained as required; maintains staff signature logs

· Ensures that the interdisciplinary team makes decisions for either completing or not completing additional MDS assessments based on clinical criteria as identified in the RAI manual

· Responds to change in conditions appropriately

· Coordinates scheduling notice of patient care planning conference and assures communication of outcomes/problems to the responsible staff, patient and/or responsible party

· Ensures all MDS information and care delivered as outlined in the Care Plan is supported by documentation

· Assist the Administrator/Director of Nursing with monitoring to ensure that a care plan is initiated on every patient upon admission to the center

· Participates in the daily Interdisciplinary Team meeting and communicates needs for changes in PPS Timeliness and Assessment Reference Dates and deficiencies in completion of MDS, CAA and Care Plan

· Relays and/or acts upon information from the Clinical Reimbursement Specialist audits

· Acts as a resource person for computer issues that relate to the MDS process; contacts the help desk when indicated. Maintains proficiency in software programs

· Responsible for ensuring appropriate Medicare coverage through regular communication with Clinical Reimbursement Specialist

· Sequence appropriate diagnosis coding for residents

· Corrects and ensures completion of final MDS and submits resident assessment data to the appropriate state and Federal government agencies in a timely manner

· Assigns, assist and instructs all staff in the RAI Process, PPS Medicare, Medicaid (Case Mix as required) and clinical computer system in relation to these processes

· Ensures timely submission of the MDS to the state with proper follow up on validation errors; maintains validation records from the submission process in a systematic and orderly fashion

· Maintains confidentiality of necessary information

· Maintains assessment on the active clinical record for at least 15 months

· Remains proactive with staying current on all industry changes

· Assist with OTG reviews, ADR's, RAC audits, etc. as needed with professionalism

· Coordinates monthly Triple Check meeting for Medical billing compliance

· Completes LTCMI timely on TMHP portal and communicates with BOM regarding payer changes to ensure no loss in Medicaid payment

· As this job description is not intended to be all-inclusive, the employee will be expected to perform other duties as assigned

· Utilize electronic medical record charting: point click care

PHYSICAL REQUIREMENTS:

Have the ability to safely perform movements such as pushing, pulling, lifting, bending, kneeling, reaching and lifting up to 50 pounds with or without reasonable accommodations

WORK SCHEDULE:

As assigned, including some weekends, evenings and holidays; non-exempt position

AA/EEO/M/F/D/V