Job Description

- Perform independent and/or suggested affiliate level, clinical and financial audits as warranted.
- Identify and assist with educational opportunities through audit, tracking, trending, and analyzing relevant patient data with supervisor guidance and support.
- Strategic planning as relates to ARDs to optimize appropriate revenue systems.
- Ensure IDT compliance with state/federal requirements and timeframes related to MDS, billing and care planning.
- Provide high level interpretation of revenue related data as requested.
- Identify revenue related risks associated with missing, irrelevant, erroneous clinical documentation. Assist with action plans related to such risk.
- Assist with orientation and education for CRCs and other IDT members as relates to MDS and/or reimbursement processes.
- Provide ongoing education and communication with IDT as relates to current state and federal regulation systems driven by the MDS.
- Review clinical charts to determine skilled need and assist with determining appropriate Length of Stay.
- Attest to completion of MDS at section Z. Sign MDS completion for any LPNs in the department.
- Develop and revise care plans as per facility protocol. Attend/Lead CP meetings per facility protocol.
- Conduct daily, weekly, monthly meetings related to Revenue. (Daily REV, Wkly MRA/CMI, Monthly Triple check)
- Ensure the timeliness of managed care updates.
- Assist with maintenance, risk and education related to 5 STAR Quality Measures/Value Based Purchasing, and Quality Reporting programs.
- Provide information as requested for Additional Documentation Request (ADR).
- Other related duties as assigned.

Qualifications:
- MA licensed nurse with 3+ years reimbursement or similar experience in the LTC industry.
- Computer literacy (Word, Excel, Power Point, Outlook).
- Experience with current EMR (NTT) software a plus.
- Evidence of effective written, verbal, and technological communication.
- Demonstrates excellent organization, communication, and presentation skills.
- Deadline driven, detail-oriented individual with strong analytical capabilities.
- Working knowledge of state and federal regulations governing the MDS and billing processes within a nursing facility. (CMI/PDPM/Managed care, QRP/VBP)
- Ability to communicate with and elicit support from other IDT members at the affiliate level.
- Ability to apply knowledge in state specific Medicaid and Medicare CMI/PDPM methodologies.
- Exhibits independent and self-directed work ethic.
- Must exhibit excellent interpersonal relations, time management, family and customer relations and job knowledge.
- Must be able to read, write, speak, and understand the English language.

Education
- Graduate of accredited RN Program required.
Salary starting at $45.00 per hour

Qualifications
Education
Required
Associates or better in Nursing or related field.

Experience
Preferred
1 year: Do you have Clinical Reimbursement Coordination experience?

Licenses & Certifications
Preferred
REGISTERED NURSE

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