Vivage
MDS - Clinical Reimbursement Coordinator RN
Pay Competitive Employment type Full-Time Job Description
Req#: 5314 MDS - Clinical Reimbursement Coordinator RN Denver North, 2201 Downing St, Denver, Colorado, United States of America Req #5314 Wednesday, September 21, 2022 POSITION DESCRIPTION POSITION TITLE: Clinical Reimbursement Coordinator REPORTS TO: Nursing Home Administrator DEPARTMENT: Nursing The primary responsibility of your job position is to direct, coordinate and lead MDS Systems, Medicare A, Medicare B and all other insurance providers, as well as conduct care coordination for case management following the current federal, state and local standards, guidelines and regulations that govern long term care and assisted living facilities. Incumbent is delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties to ensure appropriate reimbursement for services provided within the Center.
KEY RESPONSIBILITIES: Coordinates and manages the process of information and clinical integration from the Interdisciplinary Team (IDT): nursing, dietary, social services, restorative nursing, physician services and the rehabilitation team to ensure the appropriate level of skilled need and capturing of all resources
Perform clinical assessments and manage the data entry of residents in all care areas needed to complete regulatory/PPS and other reimbursement related MDS forms and ensure accuracy of the MDS including timely submission of the transmission process
Maintains current and comprehensive knowledge of MDS and Medicare/Medicaid reimbursement
Serves as Center resource for MDS/RUGS and Case Mix systems
Coordinates with the Business Office Manager required billing data such as: RUGs, case mix data, and insurance authorization required for billing accuracy
Assist with writing and updating Care Plans in collaboration with IDT
May direct the restorative nursing program
Assess residents for need for restraints and obtain all needed consents and physician’s orders
Assists with coordination of the process of assessing incontinent residents for need for bladder or bowel retraining or toileting programs.
Assist with implementation of adaptive behavior programs and other interventions consistent with the care plan for each individual resident.
Assist with strategies and training of Center staff in terminology, language, and format that is required for capturing the highest burden of care delivered to residents and is responsible for implementation of strategies to ensure quality outcomes and fiscal responsibility for the community assessments.
Assists with leadership within the community participating in weekly and monthly triple check, QA&A, PIC, Care Conferences, Daily Standup and PPS
Participate in pre-admission assessments and the decision making process regarding new admissions by calculating potential resource expenses, and estimate clinical reimbursement
Complete Quality Management Reports based on Quality Measures; assists in developing collaborative IDT action plans and report on process and outcomes of these action plans
Participate and assist in Clinical Center Programs such as: Restraint Management, Pain Management, Quality Management, Fall Management, and Medication Review
Assist in evaluation of the effectiveness of policies and procedures and make suggestions for revision in the interest of more effective and efficient services
Perform administrative duties such as evaluations, studies and audits as needed
Helps maintain the physical, social and psychological environment
Ability to maintain professional working relationships with all Center personnel, residents and families; present a professional image to the consumer through dress, behavior and speech
Participate in new staff general orientation
May serve on committees such as infection control, safety, Performance Improvement, Adaptive Behavior and Culture Change. May serve as chair of some of these committees; attends department supervisor and staff meetings
Must follow all safety procedures; reports accident/incident hazards; assist with infection control in identifying risks; follows established infection and universal precautions policies and procedures; monitor the use and handling of equipment to ensure safe usage and avoid waste or breakage
Maintain confidentiality of all pertinent resident care information as well as staff information; adheres to HIPAA
Trains backup personnel for the Clinical Reimbursement Coordinator
Complete “Nonviolent Crisis Intervention” training per facility protocol
Perform all other duties as assigned
TALENT: Relationship Building Have a caring attitude and sincere interest in others Demonstrate friendliness and enthusiasm Build relationships with all types of people Influencing Communicate effectively Flexibility Executing Self-directed Ability to organize and prioritize Ability to exercise judgment and display understanding Detail oriented and follow through Strategic Thinking Solve problems effectively Creative in coming up with options and variety Curiosity and desire to learn
SKILLS AND KNOWLEDGE: Maintains strong working knowledge of the Resident Assessment Instrument (RAI) Manual as well as complete the required courses for credentialing through the American Association of Nurse Assessment Coordinators and maintain certification thereafter
Prefer knowledge of Medicare/Medicaid and insurance reimbursement procedures, contracts, clinical resource utilization and/or case management (can be trained)
Must have basic computer operation and typing skills for efficient data input; must be able to navigate touchscreen computers
Knowledgeable of nursing and medical practices and procedures as well as regulations and guidelines that pertain to long term care must have knowledge of office machines and equipment
Must demonstrate the knowledge and skills necessary to provide care appropriate to the age-related needs of the residents served
Must be knowledgeable of laws, regulations, and guidelines pertaining to hospital and nursing facility administrative procedures
EDUCATION AND EXPERIENCE: Graduate from an accredited school of nursing
Current RN license in the State of Colorado required
Must have, as a minimum, three (3) years’ experience in an administrative supervisory capacity in a hospital or nursing facility
Experience in rehabilitation and/or geriatric nursing is desirable
JOB TRAINING: How long it usually takes to completely perform this job when the incumbent has the minimum knowledge, skills, abilities, work experience and/or education: up to 1 year
WORK ENVIRONMENT: Works in all areas of the facility
Moves intermittently during working hours
Is subject to frequent interruptions
Is involved with residents, personnel, visitors, government agencies/personnel, etc., under all conditions and circumstances
Is subject to hostile and emotionally upset residents, family members, etc
Communicates with the maintenance personnel, nursing staff, and other department supervisors
Works beyond normal duty hours, on weekends, and in other positions temporarily, when necessary
Is subject to call back during emergency conditions (e.g., severe weather, evacuation, post-disaster, etc.)
Is subject to injury from falls, burns from equipment, odors, etc.throughout the workday, as well as reactions from dust, disinfectants, tobacco smoke, and other air contaminants
Is subject to exposure to infectious waste, diseases, conditions, etc., including TB and the AIDS and Hepatitis B viruses
May be subject to the handling of and exposure to hazardous chemicals
PHYSICAL AND SENSORY REQUIREMENTS Must be able to relate to and work with ill, disabled, elderly, emotionally upset, and at times hostile people within the facility
Must meet the general health requirements set forth by the policies of this facility, which includes a mental and physical examination
Must possess sight/hearing senses, or use prosthetics that will enable these senses to function adequately so that the requirements of this position can be fully met
Must be able to push, pull, move, and /or lift a minimum of 25 pounds to a minimum height of 5 feet and be able to push, pull, move, and/or carry such weight a minimum distance of 50 feet
May be necessary to assist in the evacuation of residents during emergency situations
OTHER: We are an Equal Opportunity Employer, Gender/Minority/Veterans/Disabled.
COVID VACCINE OR QUALIFYING EXEMPTION REQUIRED
It must be understood that this job description in no way states or implies that these are the only duties you will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position. Other details
Pay Type Hourly Employment Indicator Regular Apply Now
Vivage's priority is to promote health, wellness, and personal lifestyle choices throughout our care communities in Colorado and Missouri. Notice
Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at accessibility@talentify.io or 407-000-0000. Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility. An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report . NYC applicants may request an alternative process or accommodation at aedt@talentify.io or 407-000-0000.
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Pay Competitive Employment type Full-Time Job Description
Req#: 5314 MDS - Clinical Reimbursement Coordinator RN Denver North, 2201 Downing St, Denver, Colorado, United States of America Req #5314 Wednesday, September 21, 2022 POSITION DESCRIPTION POSITION TITLE: Clinical Reimbursement Coordinator REPORTS TO: Nursing Home Administrator DEPARTMENT: Nursing The primary responsibility of your job position is to direct, coordinate and lead MDS Systems, Medicare A, Medicare B and all other insurance providers, as well as conduct care coordination for case management following the current federal, state and local standards, guidelines and regulations that govern long term care and assisted living facilities. Incumbent is delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties to ensure appropriate reimbursement for services provided within the Center.
KEY RESPONSIBILITIES: Coordinates and manages the process of information and clinical integration from the Interdisciplinary Team (IDT): nursing, dietary, social services, restorative nursing, physician services and the rehabilitation team to ensure the appropriate level of skilled need and capturing of all resources
Perform clinical assessments and manage the data entry of residents in all care areas needed to complete regulatory/PPS and other reimbursement related MDS forms and ensure accuracy of the MDS including timely submission of the transmission process
Maintains current and comprehensive knowledge of MDS and Medicare/Medicaid reimbursement
Serves as Center resource for MDS/RUGS and Case Mix systems
Coordinates with the Business Office Manager required billing data such as: RUGs, case mix data, and insurance authorization required for billing accuracy
Assist with writing and updating Care Plans in collaboration with IDT
May direct the restorative nursing program
Assess residents for need for restraints and obtain all needed consents and physician’s orders
Assists with coordination of the process of assessing incontinent residents for need for bladder or bowel retraining or toileting programs.
Assist with implementation of adaptive behavior programs and other interventions consistent with the care plan for each individual resident.
Assist with strategies and training of Center staff in terminology, language, and format that is required for capturing the highest burden of care delivered to residents and is responsible for implementation of strategies to ensure quality outcomes and fiscal responsibility for the community assessments.
Assists with leadership within the community participating in weekly and monthly triple check, QA&A, PIC, Care Conferences, Daily Standup and PPS
Participate in pre-admission assessments and the decision making process regarding new admissions by calculating potential resource expenses, and estimate clinical reimbursement
Complete Quality Management Reports based on Quality Measures; assists in developing collaborative IDT action plans and report on process and outcomes of these action plans
Participate and assist in Clinical Center Programs such as: Restraint Management, Pain Management, Quality Management, Fall Management, and Medication Review
Assist in evaluation of the effectiveness of policies and procedures and make suggestions for revision in the interest of more effective and efficient services
Perform administrative duties such as evaluations, studies and audits as needed
Helps maintain the physical, social and psychological environment
Ability to maintain professional working relationships with all Center personnel, residents and families; present a professional image to the consumer through dress, behavior and speech
Participate in new staff general orientation
May serve on committees such as infection control, safety, Performance Improvement, Adaptive Behavior and Culture Change. May serve as chair of some of these committees; attends department supervisor and staff meetings
Must follow all safety procedures; reports accident/incident hazards; assist with infection control in identifying risks; follows established infection and universal precautions policies and procedures; monitor the use and handling of equipment to ensure safe usage and avoid waste or breakage
Maintain confidentiality of all pertinent resident care information as well as staff information; adheres to HIPAA
Trains backup personnel for the Clinical Reimbursement Coordinator
Complete “Nonviolent Crisis Intervention” training per facility protocol
Perform all other duties as assigned
TALENT: Relationship Building Have a caring attitude and sincere interest in others Demonstrate friendliness and enthusiasm Build relationships with all types of people Influencing Communicate effectively Flexibility Executing Self-directed Ability to organize and prioritize Ability to exercise judgment and display understanding Detail oriented and follow through Strategic Thinking Solve problems effectively Creative in coming up with options and variety Curiosity and desire to learn
SKILLS AND KNOWLEDGE: Maintains strong working knowledge of the Resident Assessment Instrument (RAI) Manual as well as complete the required courses for credentialing through the American Association of Nurse Assessment Coordinators and maintain certification thereafter
Prefer knowledge of Medicare/Medicaid and insurance reimbursement procedures, contracts, clinical resource utilization and/or case management (can be trained)
Must have basic computer operation and typing skills for efficient data input; must be able to navigate touchscreen computers
Knowledgeable of nursing and medical practices and procedures as well as regulations and guidelines that pertain to long term care must have knowledge of office machines and equipment
Must demonstrate the knowledge and skills necessary to provide care appropriate to the age-related needs of the residents served
Must be knowledgeable of laws, regulations, and guidelines pertaining to hospital and nursing facility administrative procedures
EDUCATION AND EXPERIENCE: Graduate from an accredited school of nursing
Current RN license in the State of Colorado required
Must have, as a minimum, three (3) years’ experience in an administrative supervisory capacity in a hospital or nursing facility
Experience in rehabilitation and/or geriatric nursing is desirable
JOB TRAINING: How long it usually takes to completely perform this job when the incumbent has the minimum knowledge, skills, abilities, work experience and/or education: up to 1 year
WORK ENVIRONMENT: Works in all areas of the facility
Moves intermittently during working hours
Is subject to frequent interruptions
Is involved with residents, personnel, visitors, government agencies/personnel, etc., under all conditions and circumstances
Is subject to hostile and emotionally upset residents, family members, etc
Communicates with the maintenance personnel, nursing staff, and other department supervisors
Works beyond normal duty hours, on weekends, and in other positions temporarily, when necessary
Is subject to call back during emergency conditions (e.g., severe weather, evacuation, post-disaster, etc.)
Is subject to injury from falls, burns from equipment, odors, etc.throughout the workday, as well as reactions from dust, disinfectants, tobacco smoke, and other air contaminants
Is subject to exposure to infectious waste, diseases, conditions, etc., including TB and the AIDS and Hepatitis B viruses
May be subject to the handling of and exposure to hazardous chemicals
PHYSICAL AND SENSORY REQUIREMENTS Must be able to relate to and work with ill, disabled, elderly, emotionally upset, and at times hostile people within the facility
Must meet the general health requirements set forth by the policies of this facility, which includes a mental and physical examination
Must possess sight/hearing senses, or use prosthetics that will enable these senses to function adequately so that the requirements of this position can be fully met
Must be able to push, pull, move, and /or lift a minimum of 25 pounds to a minimum height of 5 feet and be able to push, pull, move, and/or carry such weight a minimum distance of 50 feet
May be necessary to assist in the evacuation of residents during emergency situations
OTHER: We are an Equal Opportunity Employer, Gender/Minority/Veterans/Disabled.
COVID VACCINE OR QUALIFYING EXEMPTION REQUIRED
It must be understood that this job description in no way states or implies that these are the only duties you will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position. Other details
Pay Type Hourly Employment Indicator Regular Apply Now
Vivage's priority is to promote health, wellness, and personal lifestyle choices throughout our care communities in Colorado and Missouri. Notice
Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at accessibility@talentify.io or 407-000-0000. Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility. An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report . NYC applicants may request an alternative process or accommodation at aedt@talentify.io or 407-000-0000.
#J-18808-Ljbffr