Spruce Manor - West Reading, PA

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Spruce Manor, located in West Reading, PA is seeking a qualified LPN with MDS experience to provide service as the Clinical Reimbursement Specialist.

Experience in the MDS 3.0 process is required for qualified candidates.

SUMMARY OF POSITION: Under the direction of the CRC or DON ( if CRC position is currently occupied by an LPN and CRS is an RN), responsible for the coordination of the Resident Assessment Instrument ( RAI) process to ensure accurate and timely completion of resident assessments in accordance with Medicare, Medicaid, OBRA and other payor program requirements. Ensures assessments accurately reflect the physical, mental and psychosocial status of each resident; ensures accuracy of RAI to reflect optimal reimbursement for services provided; ensures appropriate documentation to report and support services provided and assessment accuracy. Communicates effectively with other members of the interdisciplinary team. Follows all Extendicare policies and procedures.

Essential Functions

1. RAI Process

Works in collaboration with the Facility Rehab Coordinator to ensure the most appropriate assessment reference date ( ARD) is utilized for Medicare Assessments through the use of the PPS Pathway.
Initiates, directs and maintains the Medicare PPS/OBRA Assessment schedules to ensure timely completion of all assessments. Collaborates with the interdisciplinary team to set appropriate ARD for all assessments.

Ensures all new admissions have an MDS completed
Ensures each quarterly MDS is accurate, complete and timely. ++
Ensures each annual assessment is accurate, complete and timely.
Collaborates with interdisciplinary team to identify significant change in status and implementation of Significant Change in Status MDS. ++
Initiates and completes Discharge and Re-entry tracking forms accurately and timely. ++
Performs Modifications/In-activations of assessment in accordance with the CMS Correction Policy .++
Verifies timely transmission of MDS Assessments, including tracking forms, to the State in accordance with EHSI standards .++
Maintains a current knowledge base regarding State and Federal Regulations, PPS and the RAI Process.

2. Case Management

  • Reviews medical records, care plans, charting to ensure documentation supports care provided and reimbursement level.
  • Participates in Quad check prior to release of claims.
  • Reviews State MDS validation reports to identify issues and/or processes to ensure accuracy of submitted MDS’s.
3. *Complies with laws and regulations applicable to position and acts in accordance with Extendicare’s Corporate Compliance Program.

4. *Attends and participates in in-service training, performance improvement ( “PI”) committees and other meetings as scheduled and directed.

5. Treats all residents, visitors, and staff with courtesy.

6. Works holiday and weekend hours as scheduled.

7. Assists in orientation and training of employees as assigned.

8. *Performs physical activities including standing, lifting ( up to 60 pounds unassisted), bending, stooping, pushing, pulling and twisting.

11. Resident Rights

  • Knows Resident Rights. Helps the residents/patients exercise and/or protect their rights.
  • Reports resident/patient complaints to management.
  • Maintains confidentiality of resident/patient information.
  • Has education or experience sufficient to meet position requirements.
  • Possesses a current license to practice in the State as an LPN
  • Able to relate positively, effectively, and appropriately with residents/patients, families, community members, volunteers and other facility staff.
Possess special interest in, and a positive attitude about, working with long-term care residents/patients and the elderly.

  • Able to read, write, speak and understand English.
  • Meets all health requirements, as required by law.
  • Working knowledge of the MDS and RAI process.
Strong interest in Medicare, Medicaid, and other payor reimbursement systems.

  • Ability to apply basic mathematical skills.
  • Basic computer skills.
  • Strong written and verbal communication skills.

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