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Job Title: Clinical Remimbursement Coordinator
Job Location: MD: Baltimore
Pay Rate: Open
Job Length: full time
Start Date: 2008-03-27
Company Name: Genesis HealthCare & Genesis Rehab Svcs
Contact: Human Resources
Phone: (610) 444-6350
Fax: (610) 925-4000
Description: Interested applicants should fax resume to Dameon Flecher
at 410-668-4328.
POSITION SUMMARY: Manages the overall process and tracking of all
Medicare/Medicaid case-mix do***ents in order to assure appropriate
reimbursement for services provided within the Center. Conducts concurrent
MDS reviews to assure achievement of maximum allowable RUG categories.
He/she will integrate information from nursing, dietary, social services,
restorative, rehabilitation and physician services to ensure appropriate
reimbursement.
RESPONSIBILITIES/ACCOUNTABILITIES:
1. Revenue Optimization & Resource Utilization:
1.1 Tracks Medicare Customers to determine continued and appropriate
Medicare eligibility and benefit period by determining skilled level of
need;
1.2 Prior to admission, reviews pre-admission intake information with the
External Care Coordinator or Admissions Coordinator to estimate RUG levels
for Medicare Customers and to identify potential resource costs, consider
formularies, and communicate findings to Administrator/care team;
1.3 Performs concurrent MDS review to insure appropriate RUGs category is
achieved through the capture of appropriate clinical information.
Identifies op****tunities to enhance reimbursement;
1.4 Directs the interdisciplinary team process to communicate
op****tunities to ensure capturing of all resources;
1.5 Collaborates with Reimbursement Services to review RUG re****ts and
identify RUG categorization.
2. MDS Schedule and Tracking:
2.1 Maintains an accurate schedule of all MDS *****sments to include the
proper reference dates throughout the Customers stay and ensures the
accurate and timely submission of the MDS *****sments including case-mix,
OBRA and OSRA required *****sments;
2.2 Communicates to the Care Plan Coordinator the MDS *****sment schedule
to ensure timely facilitation of the care planning process.
2.3 Completes the admission and discharge tracking form and maintains
tracking system for admission/re-entry/discharge;
2.4 Manage the data entry function to ensure the accuracy of the MDS and
verify electronic transmissions to Genesis and the state.
3. Billing:
3.1 Coordinate with the Center Business Office, and or/Centralized
Business Office when available throughout the month, to communicate
case-mix data required for billing such as RUGs categories, modifiers,
state case-mix scores, etc.
4. Education and Resource:
4.1 Serves as the Center resource for MDS/RUGs and state case-mix
systems;
4.2 Provides case-mix education to the interdisciplinary team as
appropriate;
4.3 Instructs Center staff in terminology, language, and format that is
required by MDS;
4.4 Communicates with Center Administrator, interdisciplinary team and
Reimbursement Services regarding any changes in case-mix regulations such
as PPS and/or state specific case-mix systems;
4.5 Trains backup personnel for the Clinical Reimbursement Coordinator;
5. Other Duties
5.1 Assists in the preparation of all requests from appropriate State
and/or federal regulatory agencies or agents regarding payment of services
(reconsideration, denials appeals, etc.);
5.2 Maintains all re****ts and transmission data in a systematic format
and stores in a safe, locked area;
5.3 Maintains a current and comprehensive knowledge of MDS and Medicare/
Medicaid reimbursement;
5.4 Implements all required forms, procedures and processes relative to
job responsibilities;
5.5 Performs other related duties as requested.
SPECIFIC EDUCATIONAL/VOCATIONAL REQUIREMENTS:
1. Graduate of an accredited School of Nursing with current RN licensure
in the state in which employment occurs is required.
2. One year of long term care clinical nursing experience is required.
3. Experience with Medicare/Medicaid reimbursement, MDS completion,
clinical resource utilization and/or case management is highly desirable.
4. Experience with basic computer technology.
18186
Please refer to Job code 18186 when responding to this ad.
For FASTEST PROCESSING of your resume, please visit
http://www.jobcircle.com/classifieds/1169301.html?source=ng
to apply
online.
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For fastest processing of your resume, this employer asks that
you apply to this job using the URL above.
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