Genesis Healthcare Coord-Clinical Reimb LPN NonExempt (Full Time) in Wakefield, Massachusetts

WAKEFIELD CENTER IS LOOKING FOR A CLINICAL REIMBURSEMENT COORDINATOR.

MUST BE EXPERIENCED IN MMQ PROCESS.

POSITION SUMMARY: The Clinical Reimbursement Coordinator (LPN) manages the overall process and tracking of all Medicare/Medicaid case-mix documents 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 opportunities to enhance reimbursement;

1.4 Directs the interdisciplinary team process to communicate opportunities to ensure capturing of all resources;

1.5 Collaborates with Reimbursement Services to review RUG reports and identify RUG categorization.

  1. MDS Schedule and Tracking:

2.1 Maintains an accurate schedule of all MDS assessments to include the proper reference dates throughout the Customer's stay and ensures the accurate and timely submission of the MDS assessments including case-mix, OBRA and OSRA required assessments;

2.2 Communicates to the Care Plan Coordinator the MDS assessment 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.

  1. 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.

  1. 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;

  1. 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 reports 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.

CCRL

QUALIFICATIONS:

SPECIFIC EDUCATIONAL/VOCATIONAL REQUIREMENTS: 1. Graduate of an accredited School of Nursing with current LPN 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. 5. This position requires that the employee is able to read, write, speak and understand the spoken English language to ensure the safety and wellbeing of our patients and visitors at the work site when responding to their medical and physical needs. 6. Maintains current BLS/CPR certification (excluding ALFs/ILFs).

Position Type: Full Time

Req ID: 273001

Center Name: Wakefield Center

Genesis HealthCare, Inc. and all affiliated entities (collectively, “Genesis”) provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, gender expression, gender identity, sexual orientation, national origin, age, actual or perceived disability, marital status, pregnancy, genetic information, amnesty, military status or status as a covered veteran in accordance with applicable federal, state, and local laws. Genesis takes affirmative action to employ and advance in employment qualified minorities, women, individuals with disabilities and covered veterans. These policies are fully supported by the CEO, COO and all members of the leadership team. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact (877)456-6726. This phone number is for ADA related accommodation requests only, not for routine employment inquiries.