MDS Reimbursement Manager

St. John's is leading and inspiring a shift in society's views of elderhood. Join our family of dedicated, talented employees who are at the forefront of innovative senior services delivery in this community. St. John's embraces living every day by fostering a culture that is friendly, respectful, responsive, compassionate, innovative, and fun for both employees and the elders and residents that call St. John's home.

If this description speaks to you, continue reading about the opportunity of MDS Reimbursement Manager. This is a full-time, 40 hours per week position at St. John's Home.

Position Summary: The MDS Reimbursement Manager organizes and directs the PDPM/CMI reimbursement program with the goal of maximizing reimbursement for St. John's Home. The MDS Reimbursement Coordinator is responsible for clinical and administrative oversight of medical record documentation and required clinical assessments to ensure optimal reimbursement from Medicare, Medicaid and Private Insurances. Responsibilities include:

• Ensure Federal, State, and Private Insurance regulations are understood and applied correctly
• Report CMI value changes regularly to facility and executive leadership team as well as any impediments to success
• Accurately complete all aspects of MDS Nurse key responsibilities including:
• Coverage Determination
• Clinical record review/guidance on skilled charting
• Generation and delivery of liability notices
• Knowledge of PDPM maximization
• Completion of Nursing designated sections of MDS
• HMO Utilization review process
• All aspects of MDS Management (Scheduling, opening, completing, closing, locking, submitting, and correcting)
• Review all PPS RUG scores to maximize optimal reimbursement
• Submit electronically all MDS Assessments to CMS/ NYS DOH via the QIES system
• Coordinate HCS upload of Medicaid culling census. Responsible to review and assure the accuracy of data provided/matched
• Monitor clinical team's compliance to MDS completion per facility policy. Report compliance issues to Administrator and DON
• Directly supervise MDS Department staff (performance appraisals, disciplinary actions, weekly coverage/staffing, compliance to all facility mandatory directives)
• Is actively involved in hiring and department orientation
• Act as a clinical informatics liaison to the I.S. Department as well as facility software vendor to assure optimum function in conjunction to operational policy and regulatory governance Participates in the evaluation, consultation and education of current and future software needs as it relates to MDS, clinical documentation, and other aspects of reimbursement
• Is responsible to monitor overall Point of Care ADL Compliance and report documentation issues to facility Administrator and DON
• Communicate regularly with billing and Admission staff regarding issues of payer coverage and all payer changes relative to coverage cuts
• Assist the Business Office to research claims take-backs
• Act as a liaison for the facility toward external auditors of MDS data as well as other payer audits. This includes but is not limited to Department of Health Survey, PRI Audit, OMIG Audits, Third Party/HMO Audits, RAC and MAC reviews
• Assure all guidance regarding the delivery of liability notices is maintained. Update process and educate staff when process is changed
• Assist medical records coding of ICD-10 codes
• Submit PBJ data through QIES
• Provide education to the interdisciplinary staff regarding timely and accurate documentation in the medical record to support and or optimize the payer
• Responsible for initial and on-going education of existing and new staff on the requirements of MDS documentation as well as initial training in MDS coding/completion
• Enhance own professional growth and development through participating in educational programs, in-service meetings and workshops, and reading of current literature
• Run departmental meetings and attends other meetings as assigned by facility leadership
• Is responsible for setting up and supporting the Nursing units in driving CMI capture. Provide information on resident baseline RUG, follow report for clinical acuities, select necessary MDS ARD's so that they meet correct OBRA standards and monitor team completion/compliance
• Work closely with the Director of Restorative Rehabilitation services and Nurse Leaders to identify appropriate MDS assessment reference dates to optimize reimbursement
• Submit electronically all MDS's to CMS per RAI regulations
• Submit electronically all OBRA MDS's to CMS for Medicaid reimbursement
• Monitor MDS completion to adhere to CMS guidelines
• Provide leadership and direction to the MDS team in regard to the completion of all mandated liability notices, including but not limited to ABN, Universal Denials, NOMNC, etc. Act as a liaison to auditing body (IPRO)
• Communicate regularly with the billing, admissions, social work, nursing and medical staff in regard to the timeliness and thoroughness in reimbursement processes
• Help with other duties as needed that support the Core Team to fulfill St John's mission vision and values

Qualifications:

• Bachelor's Degree in Nursing preferred
• 3-5 years clinical nursing experience in acute or long-term care preferred
• 1-3 years of 3rd party billing experience preferred
• AANAC Certification required or ability to obtain within six months of hire
• Ability to interact with elders and care for their needs
• Willingness to embrace and exemplify St. John's Brand Characteristics

Check out what we have to offer YOU at https://www.stjohnsliving.org/careers:

• Health, dental, vision insurance (30 hours+)
• Employer sponsored life insurance & telemedicine (30 hours+)
• Weekly paychecks
• Competitive pay
• Ability to pay your bills before pay day through PayActiv: https://www.payactiv.com/employees/
• Free parking
• 24/7 fitness center
• Generous paid time off and holidays
• On-site child care
• Employee Assistance Plan
• Cell phone discounts
• Recognition activities and events

St. John's is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, disability status or any other status protected by laws and regulations.