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.
2. 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.
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.
4. 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;
5. 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.
Position Type: Full Time
Req ID: 313039
Center Name: Clipper Harbor Center