Case Mix Specialist

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          "text": "<p>Case Mix Specialist<br /><span><br /></span></p><p><span>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. <br /><br />Responsibilities:<br />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.<br />Monitors LTCQ reports for accuracy of MDS coding.<br />Monitors and assists with validation of Quality Indicator reports for accuracy of MDS coding.<br />Responsible for accuracy of MA Picture Date process for each assigned center.<br />Assists Director, Case Mix Reimbursement with developing training materials for quarterly MDS training sessions.  Presents information at quarterly MDS training sessions.<br />Monitors that facilities follow Medicare/Medicaid regulatory and HCR ManorCare reimbursement guidelines.<br />Assists nursing staff in improving MDS assessment skills through formal and informal training.  Coordinates training and communication with Clinical Services staff as needed. <br />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. <br />Monitors Corporate Compliance policies and notifies appropriate facility, regional, divisional, and corporate staff as needed.  <br />Attends and participates as needed in regional meetings, scheduled in-service programs, staff meetings and other center meetings and sits on required committees.<br />Participates in assisting facility staff with interview of ADON of Clinical Documentation and MDS Coordinator. <br />Participates in developing and updating Medicare PPS and Case Mix policies and procedures. <br />Completes and maintains records and reports as required.<br />Coordinates and promotes work between departments; Maintains confidentiality of necessary information.<br />Collaborates with corporate and/or facility staff related to denial issues affected by the MDS.<br />Works with facility, corporate and regional support staff to assure appropriate levels of reimbursement.<br />Monitors submission requirements according to Federal and State standards.<br />Monitors to assure the complete and timely submission of MDS data according to Federal and State reimbursement requirements.<br />Collaborates with the facility to keep them informed of new developments for Federal and State payment systems.<br />Remains abreast of regulatory change for Medicare/Medicaid reimbursement and communicates necessary information to appropriate personnel. <br />Communicates and coordinates the resolution of facility issues through appropriate regional and corporate departments.<br />Performs any miscellaneous work assignments as may be required.<br /><br />Educational Requirements:<br />Registered Nurse required<br /><br />Position Requirements:<br />RN License Required.<br /><br />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.<br /><br />Travel to Colorado also required. The position supports six Washington facilities and two facilities in Colorado.</span></p><p><b><br /></b><strong><b><span>2+ to 5 years experience</span></b></strong><br /><br /></p>",
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