Posted in Other 30+ days ago.
Type: Part Time
Oversees, reviews and/or completes the MDS/PPS components of the facility based MDS/PPS Programs. Completes and/or oversees completion of all Medicare PPS MDSs and/or OBRA assessments for both subacute and long-term care. Establishes the schedule for completion of the Medicare required assessments setting the completion date to maximize reimbursement and RUGs categories for each individual assessment. Acts as support/liaison to the business office coordinator and/or designee in determining eligibility for Medicare and tracking Medicare days in the facility. Serves as facility contact with Managed Care program to ensure appropriate authorization and reimbursement for facility services provided.
Knowledge of and management of NYS RUGs III case mix for Medicaid reimbursement.
Participates with Medical Records and therapy staff in preparing records for CMS and various entities for pre and post-pay record reviews, ADR requests and appeals processes.
* Registered Professional Nurse, Licensed in NYS.
* State PRI Assessor Number a plus.
* Knowledge of MDS/PPS scheduling, completion, coding and submission requirements.
* Excellent verbal and written communication skills.
* Demonstrated knowledge of NYS Medicaid program, Medicare/PPS program, Managed Care programs, RUGs Ill and RUGs IV classification and reimbursement systems, Part A coverage guidelines and documentation requirements.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.