Seeking qualified Registered Nurses ( RN) or Licensed Practical Nurses ( LPN) to provide dedicated, compassionate service to the residents in our skilled nursing care / rehabilitation center in the role of Clinical Reimbursement Specialist ( MDS Nurse).
· Under the direction of the Clinical Reimbursement Coordinator ( CRC, MDS 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.
A: 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.
B: 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.
· Complies with laws and regulations applicable to position and acts in accordance with Extendicare’s Corporate Compliance Program.
· Possesses a current license to practice in the State as an RN or LPN
· Working knowledge of the MDS and RAI process
· Strong interest in Medicare, Medicaid, and other payor reimbursement systems
· Able to relate positively, effectively, and appropriately with residents/patients, families, community members, volunteers and other facility staff.
· Able to read, write, speak and understand English.
· Ability to apply basic mathematical skills
· Basic computer skill.
· Strong written and verbal communication skills
We strive to provide our employees with the tools necessary for development and success.
Extendicare, helping people live better!