Clinical Reimbursement Coordinator/ MDS Nurse - LVN/RN at Cedar Bayou

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Focused Post Acute Care Partners FPACP is a dynamic company with an expectation of excellence in the delivery of long-term care to every patient every day. We are looking for an MDS Coordinator to join our great team!

At FPACP, we take pride in our culture and ROCKIN recognition program ROCKStar (Recognizing Outstanding Care and Kindness). This program is used across the organization for team members, residents, family members, volunteers, and business partners. The gamification component is a fun and competitive way team members level up monthly, getting one step closer to attending the annual FPACP Gala. Apply to find out more and become our next ROCKStar.

POSITION SUMMARY:

The MDS Coordinator will assist the Director of Nursing with ensuring that documentation in the center meets federal, state, and certification guidelines. The MDS Coordinator will coordinate the RAI process assuring the timeliness and completeness of the MDS, CAAS, and Interdisciplinary Care Plans.

QUALIFICATIONS:

• Must have a current LVN license
• Minimum of two (2) years nursing experience in skilled nursing facility preferred
• Excellent knowledge of RAI Process, the federal Medicare PPS process, and Medicaid reimbursement as required
• Thorough understanding of the Quality Indicator process
• Knowledge of the OBRA regulations and Minimum Data Set
• Knowledge of the care plan process

ESSENTIAL FUNCTIONS:

• To assure resident safety
• Assist the facility in assuring adherence to federal and state regulations and certification
• Actively participates in the regulatory or certification survey process and the correction of deficiencies
• Report trends from completed audits to the Quality Assurance Committee
• Assures the completion of the RAI Process from the MDS through the completion of the plan of care
• Initiates and monitors RAI process tracking, discharge/re-entry, and Medicaid tracking forms through the AHT system
• Follows up with staff when necessary to assure compliance to standards of documentation
• Collect data for each resident and interview staff and residents as necessary to assure a good standard of practice and as instructed in the MDS 3.0 User manual
• Facilitates accurate determination of the Assessment Reference Date that accurately reflects the patient's care needs and captures all resources utilized to ensure appropriate payment by Medicare/Medicaid and insurance programs
• Provides an interdisciplinary schedule for all MDS assessments and care plans as required by OBRA and PPS
• Assures appropriate signatures are obtained as required; maintains staff signature logs
• Ensures that the interdisciplinary team makes decisions for either completing or not completing additional MDS assessments based on clinical criteria as identified in the RAI manual
• Responds to change in conditions appropriately
• Coordinates scheduling notice of patient care planning conference and assures communication of outcomes/problems to the responsible staff, patient, and/or responsible party
• Ensures all MDS information and care delivered as outlined in the Care Plan is supported by documentation
• Assist the Administrator/Director of Nursing with monitoring to ensure that a care plan is initiated on every patient upon admission to the center
• Participates in the daily Interdisciplinary Team meeting and communicates needs for changes in PPS Timeliness and Assessment Reference Dates and deficiencies in completion of MDS, CAA, and Care Plan
• Relays and/or acts upon information from the Clinical Reimbursement Specialist audits
• Acts as a resource person for computer issues that relate to the MDS process; contacts the help desk when indicated. Maintains proficiency in software programs
• Responsible for ensuring appropriate Medicare coverage through regular communication with Clinical Reimbursement Specialist
• Sequence appropriate diagnosis coding for residents
• Corrects and ensures completion of final MDS and submits resident assessment data to the appropriate state and Federal government agencies in a timely manner
• Assigns, assist, and instructs all staff in the RAI Process, PPS Medicare, Medicaid (Case Mix as required), and clinical computer system in relation to these processes
• Ensures timely submission of the MDS to the state with proper follow up on validation errors; maintains validation records from the submission process in a systematic and orderly fashion
• Maintains confidentiality of necessary information
• Maintains assessment on the active clinical record for at least 15 months
• Remains proactive with staying current on all industry changes
• Assist with OTG reviews, ADR's, RAC audits, etc. as needed with professionalism
• Coordinates monthly Triple Check meeting for Medical billing compliance
• Completes LTCMI timely on TMHP portal and communicates with BOM regarding payer changes to ensure no loss in Medicaid payment
• As this job description is not intended to be all-inclusive, the employee will be expected to perform other duties as assigned
• Utilize electronic medical record charting: point click care

PHYSICAL REQUIREMENTS:

Have the ability to safely perform movements such as pushing, pulling, lifting, bending, kneeling, reaching and lifting up to 50 pounds with or without reasonable accommodations

We offer great benefits to our valued team members!

Excellent compensation - 6 Holidays - Life Insurance- Short Term and Long Term Disability

• Health Plans
• Vision
• Dental
• Generous PTO
• DailyPay Available
• Much More

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