PCC/MDS Coordinator

4 days ago


Carrollton, Texas, United States Cantex Continuing Care Network Full time
Job Summary:

The PCC/MDS Coordinator plays a crucial role in ensuring accurate and timely reimbursement for Medicare and Medicaid patients. This position is responsible for managing the Patient Assessment Instrument (RAI) process, ensuring compliance with federal and state regulations, and collaborating with the interdisciplinary team to deliver high-quality patient care.

Key Responsibilities:
  • Maintains compliance with all State and Federal Medicaid and/or Medicare rules, regulations, and published interpretations.
  • Participates in the assessment of pre-admission paperwork to ensure patients meet qualifying medical necessity determination.
  • Coordinates the Weekly Reimbursement Meeting with the Interdisciplinary Team Members to ensure proper Medicare and/or Medicaid reimbursement to match care delivery.
  • Audit the Clinical Record to ensure appropriate documentation for actual care delivery.
  • Obtains Medicare qualifying diagnosis(es) on Medicare Part A patients and updates diagnosis for each change in diagnosis.
  • Initiates and updates the physician certifications for each Medicare Part A patient.
  • Completes all Minimum Data Set (MDS) assessments within the allotted time frame for each Medicare and/or Medicaid patient.
  • Reviews the 24-hour Nursing report to capture possible change in condition of a patient.
  • Prepares for all Medicaid audits.
  • Tracks patient benefit days, validates daily census, and coordinates information with the Financial Manager to ensure accurate billing.
  • Achieves at least budgeted rates expectation.
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 at times, delegate tasks.
  • Ability to read, write, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
  • Ability to write reports, business correspondence, nursing/patient progress notes, and nursing procedures.
About Cantex Continuing Care Network:

Cantex Continuing Care Network is committed to a culture that respects our differences and values the contributions of all people. We strive to provide high-quality patient care and ensure accurate reimbursement for our patients. If you are a motivated and detail-oriented individual with a passion for patient care, we encourage you to apply for this exciting opportunity.


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