Clinical Reimbursement Specialist/MDS Coordinator (RN)
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Our management company, VIVAGE SENIOR LIVING, is a nationally recognized leader and innovator in the long-term care industry. VIVAGE SENIOR LIVING is dedicated to person-centered care and we embrace the Eden Alternative™ philosophy. We bring “quality of life in aging” and “living well” to Long Term Care!
Currently, Riverdale Rehab and Care Community of Brighton is seeking a Full Time CLINICAL REIMBURSEMENT/MDS COORDINATOR at their 107 bed skilled nursing community located in Brighton, CO.
The primary responsibility of the CLINICAL REIMBURSEMENT/MDS COORDINATOR 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 are provided within the Center.
- 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.
- Graduate from an accredited school of nursing; current RN license in the State of Colorado preferred.
- Must have, as a minimum, three (3) years experience in an administrative supervisory capacity in a hospital or nursing facility.
- 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.
- Be able to assess residents and relate information regarding resident’s condition.
- Must have knowledge of Medicare/Medicaid and insurance reimbursement procedures, contracts, clinical resource utilization and/or case management.
- Must have basic computer operation and typing skills for efficient data input; must be able to navigate touchscreen computers.
- Must have knowledge of office machines and equipment.
- Must be able to read, write, speak and understand the English language.
- Ability to make independent decisions when circumstances warrant such action.
- Must possess the ability to deal tactfully when personnel, residents, family members, visitors, government agencies/personnel and the general public.
- Knowledgeable of nursing and medical practices and procedures as well as regulations and guidelines that pertain to long term care.
- Must have patience and enthusiasm, as well as, the willingness and ability to handle difficult residents.
- Open to new ideas and be willing to incorporate them into practice.
- Experience in rehabilitation and/or geriatric nursing is desirable.
- Competence in supervision and leadership.
- Ability to stand up in front of entire staff and present/teach.
- Complete “Nonviolent Crisis Intervention” training per facility protocol.
- 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.
- Must possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, etc., necessary for providing quality care and maintaining a sound operation.
- Must be able to communicate policies, procedures, regulations, reports, etc., to personnel, residents, family members, visitors, and government agencies/personnel.
- Must not pose a direct threat to the health or safety of other individuals in the workplace.