Care Specialist

1 week ago

creve coeur, United States Bethesda Health Full time
Bethesda Brings out the Best in Talented, Caring People
At Bethesda, more than 1,200 employees dedicate their careers to improving the lives of others.
As a team member at Bethesda, you‘ll enjoy great benefits such as: 403b, daily pay, bonuses, career advancement opportunities, and holiday pay.
Medical, dental, vision, prescription, and life insurance available for regular status full and part time employees.
This is a Part Time Hourly Position
Summary
Responsible for conducting audits of the medical billing documentation supporting claims billed to third parties, particularly Medicare and Medicaid. These audits determine whether services provided to residents and billed, are consistent with medical record documentation and in accordance with appropriate third-party billing regulations and/or standards. Findings are communicated to appropriate personnel. Emphasis will be placed on MDS auditing and best practices documentation.
Conducts internal audits of medical documentation supporting claims billed to third parties and billing is done in accordance with appropriate third-party regulations/standards.
Assists in education of clinicians and billing staff to support compliance with third party documentation and billing standards.
Provides education to clinical staff in the proper use of EMR reports related to documentation in the MDS.
Prepares written reports of the results of the audits and presents them to management and billing staff with recommended corrective actions.
Responds to questions from nursing / billing staff regarding billing, coding and documentation.
Works on joint projects with other internal compliance staff to resolve billing and documentation issues.
Follows established policies and procedures, quality assurance, safety, environmental and infection control standards. Assists with periodic clinical reviews of long-term care communities in preparation for governmental or other accrediting body inspections.
Assists with periodic review of Quality Measures and education of the interdisciplinary team.
Monitors documentation patterns for accuracy of information through the use of reporting mechanisms within the electronic medical record software.
Job Qualifications
Registered nurse, bachelor degree preferred
Active RN license in Missouri and Illinois, or willing to obtain as soon as possible
Two years of Long-Term care experience, with at least one year as MDS Coordinator
Acute care highly desirable
Knowledge of Medicare and Medicaid required
Experience training/teaching adults preferred
Software skills in Word, Excel, Power Point or equivalent required
Basic knowledge of and experience utilizing a personal computer
Verbal and written communication skills
Excellent interpersonal and organizational skills
Manual dexterity, coordination and skillful use of hands for working with required equipment
Ability to receive and express detailed information through oral communication, visual acuity
Ability to read and understand written directions
Category: RN
RN Care Specialist at Bethesda Health summary: The RN Care Specialist at Bethesda is responsible for conducting audits of medical billing documentation to ensure compliance with third-party regulations, especially Medicare and Medicaid. This role includes educating clinical and billing staff on proper documentation and MDS auditing practices, as well as preparing reports and providing recommendations for corrective actions. The position requires a registered nurse with a focus on long-term care experience and strong communication skills.
Keywords: RN Care Specialist, medical billing auditing, MDS Coordinator, Medicare, Medicaid, healthcare compliance, clinical education, long-term care, documentation standards, nursing

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