· Perform independent and/or suggested affiliate level, clinical and financial audits as warranted.
· Identify and assist with educational opportunities through audit, tracking, trending, and analyzing relevant patient data with supervisor guidance and support.
· Strategic planning as relates to ARDs to optimize appropriate revenue systems.
· Ensure IDT compliance with state/federal requirements and timeframes related to MDS, billing and care planning.
· Provide high level interpretation of revenue related data as requested.
· Identify revenue related risks associated with missing, irrelevant, erroneous clinical documentation. Assist with action plans related to such risk.
· Assist with orientation and education for CRCs and other IDT members as relates to MDS and/or reimbursement processes.
· Provide ongoing education and communication with IDT as relates to current state and federal regulation systems driven by the MDS.
· Review clinical charts to determine skilled need and assist with determining appropriate Length of Stay.
· Attest to completion of MDS at section Z. Sign MDS completion for any LPNs in the department.
· Develop and revise care plans as per facility protocol. Attend/Lead CP meetings per facility protocol.
· Conduct daily, weekly, monthly meetings related to Revenue. (Daily REV, Wkly MRA/CMI, Monthly Triple check)
· Ensure the timeliness of managed care updates.
· Assist with maintenance, risk and education related to 5 STAR Quality Measures/Value Based Purchasing, and Quality Reporting programs.
· Provide information as requested for Additional Documentation Request (ADR).
· Other related duties as assigned.
Qualifications:
· MA licensed nurse with 3+ years reimbursement or similar experience in the LTC industry.
· Computer literacy (Word, Excel, Power Point, Outlook).
· Experience with current EMR (NTT) software a plus.
· Evidence of effective written, verbal, and technological communication.
· Demonstrates excellent organization, communication, and presentation skills.
· Deadline driven, detail-oriented individual with strong analytical capabilities.
· Working knowledge of state and federal regulations governing the MDS and billing processes within a nursing facility. (CMI/PDPM/Managed care, QRP/VBP)
· Ability to communicate with and elicit support from other IDT members at the affiliate level.
· Ability to apply knowledge in state specific Medicaid and Medicare CMI/PDPM methodologies.
· Exhibits independent and self-directed work ethic.
· Must exhibit excellent interpersonal relations, time management, family and customer relations and job knowledge.
· Must be able to read, write, speak, and understand the English language.
Education
· Graduate of accredited RN Program required
