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VestraCare · 1 month ago

MDS RN

Roscoe, NY

Full-time

Onsite

Entry, Mid Level

$88K/yr - $90K/yr

2+ years exp

VestraCare is a healthcare company focused on providing excellent care while supporting operational excellence. The MDS RN coordinates Medicare, Managed Care, and Medicaid activities, educating facility staff and supervising MDS processes to maximize utilization and reimbursement.

Health Care

Responsibilities

Provides education and assistance to facilities on Medicare/Medicaid related areas including eligibility, certification, coverage, documentation, utilization and reimbursement. Assists facilities with initial certification procedures and follow-up of problem areas

Interacts with Medicare, Managed Care and Medicaid claims review unit and compliance unit to assist a facility in complying with company procedures and federal, state and local regulations. Reports regularly to administration on issues and activities. Interacts with the Medicare and managed Care intermediaries in areas of coverage and documentation. Assists in review and preparation of denied claims or administrative record reviews by outside intermediaries

Completes and assesses compliance with Medicare, Managed Care, Medicaid and third party payers and company procedures. Establishes systems and programs designed to correct any non-compliance situation. Participates with any outside reimbursement audits to acquire first-hand knowledge of areas that might lead to system failures

Establishes and maintains current statistical data associated with the Medicare, Managed Care and Medicaid programs by region. Cooperates with operations to monitor activities for contractor programs, i.e. therapies, utilization review. Reviews and maintains Medicare, Managed Care and Medicaid reference materials

Monitors and identifies utilization issues. Establishes systems and programs to maximize utilization and reimbursement. Monitors compliance with third party policies and procedures for authorizations for payment and provision of services

Provides ongoing orientation and training to appropriate facility staff regarding the Medicare, Managed Care and Medicaid and other contracted third party payers. Provides education regarding changes in any reimbursement program

PDPM reviews upon admission or re-admission or as indicated

Review of MDS completion for Medicare A MDS’ for compliance and accuracy

Gathers documentation for CMS audit requests and other audits as indicated

Reviews physician documentation for accurate ICD 10 coding, assisting to set and rank diagnosis for new admissions and re-admissions

MDS Integrity reviews as indicated

MDS completion as needed

Other duties as assigned

Qualification

MDS assessmentMedicare/Medicaid knowledgeReimbursement expertiseNYS RN licensurePDPM knowledgeLeadership skillsTime managementCommunication skillsInterpersonal skillsProblem-solving skillsOrganizational skills