Nurse - Assisted Living Nurse Coordinator
4 weeks ago
Balance Life & Work with a New Career Opportunity
(SKILLED NURSING)
(ASSISTED LIVING)
Now Hiring - Clinical Reimbursement Coordinator - (Livingston, NJ)
(CareOne at Livingston)
The Clinical Reimbursement Coordinator assures the implementation of company policies and procedures pertaining to the Medicare and Managed care reimbursement in the facility. This position reports to the Administrator of the facility and receives consultative assistance from the Regional Clinical Reimbursement Specialist. The Clinical Reimbursement Coordinator is also responsible for regulatory compliance and quality improvement efforts in order to attain appropriate Medicare or Managed Care reimbursement. This position integrates information from all necessary disciplines to maintain accuracy and compliance with the MDS process. By conducting concurrent MDS reviews, he/she assures the achievement of maximum allowable RUG categories. Working collaboratively with facility team members, the CRC ensures that services offered meet or exceed federal, state and company standards and serves as a role model for ethical business practices according to health standards.
Essential Duties and Responsibilities
Maintain a professional standard of behavior when interacting with staff, residents family members or visitors
Follow and uphold the company Code of Conduct
Facilitate Daily PPS and Weekly Medicare meeting
Knowledge of and compliance with HIPAA guidelines
Knowledge of and ability to download reports from Point Right
Knowledge of and ability to download state and federal reports from Internet
Participate in Monthly Billing Reconciliation meeting
Complete MDS's per schedule as required for Medicare, Managed care and OBRA schedules
Initiate/Update Care plans as required
Ensure compliance with State, Federal, and Point Right transmissions and make modifications as needed
Facilitate and coordinate with other disciplines to maintain care plan development and ongoing updates per MDS schedule
Provide updates as required per Managed Care contract guidelines
Communicate promptly with facility team/regional consultant any issues or concerns
Completion and issuance of denial letters, coordination of Medicare certification completion, review of skilled nursing documentation (including CNA documentation) to support skilled needs
Serve as the center resource for MDS/PPS; and state Medicaid reimbursement.
Manage Medicare appeals process, and participate in Administrative Law Judge hearings as needed.
Implement and participate in the company processes developed to appropriately maximize reimbursement
Position Requirements:
Graduate of an approved RN program
Current RN license in the state and credentials as required
Prior experience in Medicare reimbursement and/or MDS experience preferred
Knowledge of Managed Care reimbursement systems
Word processing and computer skills
Excellent oral and written communication skills
Excellent ability to maintain an effective, friendly working relationship with others
Basic mathematic ability; ability to use calculator
Knowledge of quality improvement process, how it affects the 5 Star report, and ability to identify issues or trends and implement corrective action plans as needed
Knowledge of the 5 Star report
Excellent attention to detail; well organized
Ability to provide one-on-one or small group education related to identified areas of need
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