What are the responsibilities and job description for the HMO Biller position at PACS?
PACS is elevating healthcare in the post-acute care space by delivering on our mission and values to create real change. By striving for the best while staying true to who we are, we’re forging a bright future for post-acute care delivery and support across the nation.
Our company is growing quickly and has many exciting milestones ahead of us. This means at PACS you will have plenty of opportunities to engage in exciting work as you grow and develop in your career. PACS is seeking a talented accounting professional to join our reporting team. You will be a key player in creating and providing valuable information to both internal and external stakeholders across the US.
This position provides support and education for nursing clinical programs Essential Duties 1. Develop, implement, educate, and monitor clinical programs that meet Professional Nursing Standard of Care and Nursing Standard of Practice per the applicable State Board of Nursing and the American Nurses Association. 2. Ensure that facilities follow all State and Federal Survey Regulations for Medicare and Medicaid Licensure Certification. 3. Assist the Administrator and/or DON in writing plan of corrections (POC) and Allegation of Compliance (AOC) for any state and federal survey deficiencies cited. Approve all POC and AOC submitted to the Office of Inspector General (OIG). 4. Monitor facility compliance with all POC submitted to OIG for recertification of Medicare and Medicaid License. 5. Oversee all reportable events that are submitted to OIG which includes: reviewing and approving all reportable documents sent to OIG and assisting facility in correction of all issues identified. 6. Provide training to facility Administration and/or staff as needed to meet Professional Nursing Standard of Care and Nursing Standard of Practice per the applicable State Board of Nursing and the American Nurses Association, and State and Federal Survey Regulations for Medicare and Medicaid Licensure Certification. 7. Assist Administrator with hiring, training, and disciplinary actions for the Director of Nursing (DON). 8. Conduct monthly Regional DON meetings for clinical program training and DON development. 9. Create and establish Regional clinical, MDS, dietary, social services and regulatory policies; And educate and provide these policies to facilities. 10. Assist DON in staffing structure and nursing PPD. 11. Conduct visits to the facility to assess, train, and monitor Administrative staff. Create action plans as needed to facilitate growth and development. 12. Attend Regional Operations meetings and give clinical insight as requested by the Director of Operations (DOP). 13. Attend all Regional meetings requested by the Director of Operations. 14. Provide oversight and direction to the MDS department. In states with case-mix reimbursement, provide education and training for Medicare and Medicaid utilization and reimbursement. Monitor Myers and Stauffer reports and assist in case-mix index (CMI) development. 15. Conduct Regional monthly MDS meetings for training and CMI development. Monitor and assist as needed, RAC audits received from Insurance, State or CMS. 16. Assist facilities with any Human Resource issues as needed. 17. Develop Regional tracking and trending reports for clinical metrics regarding CMS 5-star rating. Assist facilities in achieving 5-star rating in all categories. 18. Develop Regional Clinical reports monitoring high risk liability areas and assist facilities in areas of concern to alleviate liability risk. 19. Work with Liability Insurance company visits, POC and high-risk areas of concern. 20. Assist Regional and or company defense attorneys as needed with any lawsuits, depositions, reports, and document production. 21. Review all record requests for appropriate documents for release. Notify DOP and company attorney with adverse events or liability concerns. 22. Review and audit medical record as requested by attorney and write preliminary report or risk analysis. 23. May be required to act as an onsite Interim DON. Supervisory Requirements This position will have supervision responsibilities and clinical oversight. Qualification Education and/or Experience Required - Bachelor’s Degree in Nursing (BSN) or equivalent Accredited Nursing Program Degree Master’s Degree in Nursing preferred 20 years of Clinical and Management experience preferred. Preferred experience: MDS certified, Legal Nurse Consultant or Risk Management experience; previous Regional or Corporate Nurse experience; experience with CMS/OIG surveys including Jeopardy citations. PCC knowledge Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from managers and employees. Mathematical Skills Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. Reasoning Ability Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Certificates, Licenses, Registrations Professional License must always remain active and in good standing with the State Board of Nursing. To perform this job successfully, an individual must be proficient in the Microsoft Suite products. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee must occasionally lift and/or move up to 25 pounds. Prolonged use of a desktop or laptop computer. While performing the duties of this job, the employee is regularly required to sit, stand; walk and talk, read or hear. Frequent use of all office related equipment to include copier/scanner/fax, telephone, and a calculator. Travel by auto or airline will be required. Work Environment The work environment characteristics described here are representative of those an encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually low to moderate. Additional Information Note: Nothing in this job specification restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Critical features of this job are described under various headings above. They may be subject to change at any time due to reasonable accommodation or other reasons. The above statements are strictly intended to describe the general nature and level of the work being performed. They are not intended to be construed as a complete list of all responsibilities, duties, and skills required of employees in this position.
Our company is growing quickly and has many exciting milestones ahead of us. This means at PACS you will have plenty of opportunities to engage in exciting work as you grow and develop in your career. PACS is seeking a talented accounting professional to join our reporting team. You will be a key player in creating and providing valuable information to both internal and external stakeholders across the US.
This position provides support and education for nursing clinical programs Essential Duties 1. Develop, implement, educate, and monitor clinical programs that meet Professional Nursing Standard of Care and Nursing Standard of Practice per the applicable State Board of Nursing and the American Nurses Association. 2. Ensure that facilities follow all State and Federal Survey Regulations for Medicare and Medicaid Licensure Certification. 3. Assist the Administrator and/or DON in writing plan of corrections (POC) and Allegation of Compliance (AOC) for any state and federal survey deficiencies cited. Approve all POC and AOC submitted to the Office of Inspector General (OIG). 4. Monitor facility compliance with all POC submitted to OIG for recertification of Medicare and Medicaid License. 5. Oversee all reportable events that are submitted to OIG which includes: reviewing and approving all reportable documents sent to OIG and assisting facility in correction of all issues identified. 6. Provide training to facility Administration and/or staff as needed to meet Professional Nursing Standard of Care and Nursing Standard of Practice per the applicable State Board of Nursing and the American Nurses Association, and State and Federal Survey Regulations for Medicare and Medicaid Licensure Certification. 7. Assist Administrator with hiring, training, and disciplinary actions for the Director of Nursing (DON). 8. Conduct monthly Regional DON meetings for clinical program training and DON development. 9. Create and establish Regional clinical, MDS, dietary, social services and regulatory policies; And educate and provide these policies to facilities. 10. Assist DON in staffing structure and nursing PPD. 11. Conduct visits to the facility to assess, train, and monitor Administrative staff. Create action plans as needed to facilitate growth and development. 12. Attend Regional Operations meetings and give clinical insight as requested by the Director of Operations (DOP). 13. Attend all Regional meetings requested by the Director of Operations. 14. Provide oversight and direction to the MDS department. In states with case-mix reimbursement, provide education and training for Medicare and Medicaid utilization and reimbursement. Monitor Myers and Stauffer reports and assist in case-mix index (CMI) development. 15. Conduct Regional monthly MDS meetings for training and CMI development. Monitor and assist as needed, RAC audits received from Insurance, State or CMS. 16. Assist facilities with any Human Resource issues as needed. 17. Develop Regional tracking and trending reports for clinical metrics regarding CMS 5-star rating. Assist facilities in achieving 5-star rating in all categories. 18. Develop Regional Clinical reports monitoring high risk liability areas and assist facilities in areas of concern to alleviate liability risk. 19. Work with Liability Insurance company visits, POC and high-risk areas of concern. 20. Assist Regional and or company defense attorneys as needed with any lawsuits, depositions, reports, and document production. 21. Review all record requests for appropriate documents for release. Notify DOP and company attorney with adverse events or liability concerns. 22. Review and audit medical record as requested by attorney and write preliminary report or risk analysis. 23. May be required to act as an onsite Interim DON. Supervisory Requirements This position will have supervision responsibilities and clinical oversight. Qualification Education and/or Experience Required - Bachelor’s Degree in Nursing (BSN) or equivalent Accredited Nursing Program Degree Master’s Degree in Nursing preferred 20 years of Clinical and Management experience preferred. Preferred experience: MDS certified, Legal Nurse Consultant or Risk Management experience; previous Regional or Corporate Nurse experience; experience with CMS/OIG surveys including Jeopardy citations. PCC knowledge Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from managers and employees. Mathematical Skills Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. Reasoning Ability Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Certificates, Licenses, Registrations Professional License must always remain active and in good standing with the State Board of Nursing. To perform this job successfully, an individual must be proficient in the Microsoft Suite products. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee must occasionally lift and/or move up to 25 pounds. Prolonged use of a desktop or laptop computer. While performing the duties of this job, the employee is regularly required to sit, stand; walk and talk, read or hear. Frequent use of all office related equipment to include copier/scanner/fax, telephone, and a calculator. Travel by auto or airline will be required. Work Environment The work environment characteristics described here are representative of those an encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually low to moderate. Additional Information Note: Nothing in this job specification restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Critical features of this job are described under various headings above. They may be subject to change at any time due to reasonable accommodation or other reasons. The above statements are strictly intended to describe the general nature and level of the work being performed. They are not intended to be construed as a complete list of all responsibilities, duties, and skills required of employees in this position.
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