Case Mix Specialist

About the role

Responsible to review Medicare/Medicaid documentation to assist nursing centers in completing MDS 3.0 documentation to assure appropriate levels of Medicare and/or Medicaid reimbursement.

Responsibilities

• Reviews MDS 3.0 documentation for accuracy and appropriateness; Audits resident’s chart to monitor that services match resident needs and documentation reflects categories for case mix reimbursement.
• Monitors LTCQ reports for accuracy of MDS coding.
• Monitors and assists with validation of Quality Indicator reports for accuracy of MDS coding.
• Responsible for accuracy of MA Picture Date process for each assigned center.
• Assists Director, Case Mix Reimbursement with developing training materials for quarterly MDS training sessions. Presents information at quarterly MDS training sessions.
• Monitors that facilities follow Medicare/Medicaid regulatory and HCR ManorCare reimbursement guidelines.
• Assists nursing staff in improving MDS assessment skills through formal and informal training. Coordinates training and communication with Clinical Services staff as needed.
• Performs audits per company and divisional standards and policies. Reviews required documentation tools; for example, RUG III Billing Log, to ensure appropriate levels of reimbursement.
• Monitors Corporate Compliance policies and notifies appropriate facility, regional, divisional, and corporate staff as needed.
• Attends and participates as needed in regional meetings, scheduled in-service programs, staff meetings and other center meetings and sits on required committees.
• Participates in assisting facility staff with interview of ADON of Clinical Documentation and MDS Coordinator.
• Participates in developing and updating Medicare PPS and Case Mix policies and procedures.
• Completes and maintains records and reports as required.
• Coordinates and promotes work between departments; Maintains confidentiality of necessary information.
• Collaborates with corporate and/or facility staff related to denial issues affected by the MDS.
• Works with facility, corporate and regional support staff to assure appropriate levels of reimbursement.
• Monitors submission requirements according to Federal and State standards.
• Monitors to assure the complete and timely submission of MDS data according to Federal and State reimbursement requirements.
• Collaborates with the facility to keep them informed of new developments for Federal and State payment systems.
• Remains abreast of regulatory change for Medicare/Medicaid reimbursement and communicates necessary information to appropriate personnel.
• Communicates and coordinates the resolution of facility issues through appropriate regional and corporate departments.
• Performs any miscellaneous work assignments as may be required.

Educational Requirements

Registered Nurse required

Position Requirements

• RN License Required.
• Three to five years previous MDS experience preferred; Strong management and interpersonal skills; Case Mix experience recommended; Computer literate and proficient with applications in the clinical area.
• Travel to Colorado also required. The position supports six Washington facilities and two facilities in Colorado.
• 2+ to 5 years experience

Additional Information

All your information will be kept confidential according to EEO guidelines.