Reimbursement Nurse Specialist

2 months ago

Rochester, United States St. Ann's Community Full time

Reimbursement Nurse Specialist

Join us in caring for the most important people on Earth We reward hard-working and caring professionals with competitive pay, great benefits, and career growth opportunities.

The purpose of this position is to Manage the Reimbursement process on assigned floors, serve as a mentor for all staff with MDS completion responsibilities, complete all MDSs, and maximize Medicaid reimbursement. Monitor resident’s skilled care eligibility, serve as a liaison between St. Ann’s Community and insurance companies, complete MDSs and maximize Medicare reimbursement.

St. Ann’s Community Offers:

Full time position (Exempt) Salary range - $79k - $97K per year Tuition Reimbursement and Scholarship Opportunities Dental, Health & Vision 403(b) Retirement Plan Opportunities for growth and advancement

Job Description:

Communicate with insurance companies as needed to maintain the resident’s coverage. Participate in weekly interdisciplinary rounds meetings on TCC as part of the process for assessing continued skilled eligibility. Assure Medicare Certification form completion according to regulatory specifications. Monitor Insurance, Part A covered residents for continued eligibility and communicate to all necessary parties when the coverage ends. Follow all Medicare residents, who have been cut from Medicare, during their 30-day window of eligibility for re-coverage. Provide documentation as needed for IPRO Appeals.  Create and deliver NOMNC, ABN, and DEONC… according to the regulatory specifications Complete MDS assessments according to schedule parameters with signing of MDS (Z0500) done by RN. Monitor for opportunities to increase RUG classification and ADL scores. Manage the MDS schedules (OBRA, PPS, and OMRA) and make changes to MDS schedule as needed to maximize RUG classification. Monitor timely completion of MDSs to comply with RAI submission guidelines. Communicate with other disciplines as needed. Schedule routine nursing tools according to the OBRA schedule. Participate in established meetings with Administrator and department manager. Regulatory Compliance/Corporate Compliance: Knowledge of the rules and regulations related to the organization, i.e. OMIG, DOH etc. Take part in special task forces and teams as requested. Eager to enhance professional growth and development through continued self-education in the MDS/

RAI process and Medicare skilled care guidelines.

Organize and maintain files and other records. Prepare/attend Triple Check monthly. Create, update and communicate the care plan schedule to the IDT.

Candidate Requirements:

Current RN license or current LPN license Able to gain knowledge of and experience in MDS completion, Medicare skilled care guidelines, and understanding of the Resident Assessment Instrument. Have or work toward AANAC MDS Certification within first year of employment. Work towards a PRI (if RN) certification.

Join us in Caring for the Most Important People on Earth

The employment policy of St. Ann’s Community is to provide equal opportunity to all persons. Our company, therefore, has made a commitment to equal employment opportunity through a positive and continuing Affirmative Action Program. No employee or applicant for employment will be discriminated against because of race, color, religion, sex, national origin, age, disability, veteran status or any other Federal or State legally-protected classes.

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