Care Coordination Specialist
5 days ago
Cantex Continuing Care Network is seeking a highly skilled PCC/MDS Coordinator to join our team. As a Care Coordination Specialist, you will play a vital role in ensuring the proper reimbursement of Medicare and/or Medicaid patients through the Patient Assessment Instrument (RAI) process.
Key Responsibilities:
- Maintain compliance with State and Federal regulations and published interpretations regarding Medicaid and/or Medicare rules.
- Participate in pre-admission paperwork review to ensure patients meet qualifying medical necessity determination.
- Attend standup meetings every weekday morning and coordinate the Weekly Reimbursement Meeting with Interdisciplinary Team Members.
- Audit Clinical Records to ensure accurate documentation for care delivery and educate staff on documentation guidelines.
- Obtain Medicare qualifying diagnoses and update physician certifications for each Medicare Part A patient.
- Complete Minimum Data Set (MDS) assessments within the allotted timeframe for each Medicare and/or Medicaid patient.
- Review 24-hour Nursing reports to capture possible changes in patient condition and prepare for Medicaid audits.
- Track patient benefit days, validate daily census, and coordinate information with Financial Manager to ensure accurate billing.
- Achieve at least budgeted rate expectations.
- Supports and upholds Patient Care Management Systems as well as Financial Management Systems.
About Us
Cantex Continuing Care Network offers a dynamic work environment with opportunities for growth and development. Our commitment to quality patient care and excellent customer service sets us apart from other healthcare providers.
Requirements
- A current, valid Texas nursing license is required (RN, LVN)
- At least 2 years of LTC experience preferred
- Must have an Acknowledgement of Completion Certificate through the HHSC RUG Online Training for Nursing Facilities
- Must complete the American Association of Nurse Assessment Coordinators (AANAC) RAI Certification within 1 year of employment
- Ability to effectively communicate, direct, and delegate tasks
- Ability to read, write, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations
We Offer
- An estimated salary of $65,000 - $80,000 per year, depending on experience
- A competitive benefits package including medical, dental, and supplemental insurance plans
- A highly competitive compensation package
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