Clinical Reimbursement Specialist / MDS Nurse
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![]() United States, California, San Diego | |
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Overview
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Vi at La Jolla Village is located at 8515 Costa Verde Blvd, San Diego CA 92122 Responsibilities Clinical Reimbursement Specialist (CRS) - Nurse Collaborates with the DON, CRM (where applicable) and various disciplines to assist in the completion of the Minimum Data Set (MDS), Resident Assessment Instrument (RAI), and all associated processes. With guidance and oversight from the DON or CRM (where applicable), the CRS ensures completion of the assessment within the timeframe as mandated by federal regulations and company policies. The CRS manages the overall resident assessment process and tracking of all Medicare/Managed Care/Medicaid case mix documents in order to ensure appropriate and optimal reimbursement for services provided within the Care Center. Responsibilities also include assisting with the coordination of resident care planning processes under the direction of the DON or CRM (where applicable). Performs other duties as assigned. Performs duties in a timely and efficient manner. This is a safety sensitive position. Principal Accountabilities / Essential Job Functions:
* Reviews the clinical records, MD progress notes, therapy and nursing documentation in order to capture all care and services for optimal reimbursement.
* Ensures that participants in the assessment process complete an accurate and comprehensive assessment.
* Tracks Medicare/Managed Care Beneficiaries to determine continued and appropriate Medicare eligibility and benefit period by determining skilled level of need.
* Performs concurrent and ongoing MDS review to ensure appropriate PDPM category is achieved through the capture of appropriate clinical information.
* Manages the coordination of ICD-10 coding for Medicare and Managed Care billing.
* Directs the interdisciplinary team process to communicate opportunities to ensure capturing of all care, services, and diagnosis.
* Coordinates with rehabilitation services Program Director, Corporate Director of Clinical Reimbursement and Central Billing Office as needed to communicate case mix data required for accurate claim billing at month end.
* Reviews additional document requests by local Medicare Administrative Contractors, insurance carriers or auditors to ensure appropriate documentation is submitted timely for review.
* Encourages staff to report changes in the resident's status and involves the DON and CRM (where applicable) in addressing concerns.
Completes resident assessment protocol documents within RN/LPN/LVN scope of practice.
* Assists with the completion of the resident care plan and the care plan conferences per requirements with supervision and guidance from the DON or CRM (where applicable).
* Provides resident and family education within RN/LPN/LVN scope of practice.
* Identifies and reports deviations from safe practice to the DON or CRM (where applicable). Adheres to policies and guidelines of regulatory agencies (i.e. OSHA, CMS).
* Manages emergency situations based on the Company's safety and disaster policies.
* Participates in quality assessment/performance improvement activities and audits as assigned and overseen by the DON or CRM (where applicable).
* Maintains minimum data set competencies and attends annual educational programs.
* Attends/participates in care center meetings, in-services and committee meetings.
* May perform CPR, use Automated External Defibrillator (AED), and render first aid in emergency situations. Qualifications Education and Experience:
Key Competencies:
The application window is anticipated to close within 30 days of the date of the posting. Pay Range USD $37.79 - USD $56.10 /Hr. |