Responsible for the effective implementation of the overall PPS process, including timely and accurate completion and transmission of MDS''s. Manages the Medicare residents from pre-admission to discharge. Insures appropriate documentation to support skilled coverage.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Evaluate all inquiries/admissions/re-admissions for possible Medicare coverage. Review new admit packets and initiate the pre-RUG process. Work with PPS team in determining appropriate RUGS level.
- Possess and maintain good clinical knowledge of all Medicare residents.
- Ensure Medicare coverage guidelines are met daily for all skilled residents including opening, completing and transmitting Medicare MDS timely physician certifications and supportive documentation.
- Attend care plan and discharge planning meetings as scheduled.
- Complete triple check monthly to ensure accurate billing.
- Coordinate nursing services with all other resident care services to assure the smooth integration of Gulf Coast Health Care''s interdisciplinary approach to quality resident care. Facilitate communication of the PPS team and daily RUGS meetings. Coordinate with medical records to assure physicians meet government regulations on skilled residents.
- Maintain a working knowledge of and ensure compliance with all governmental regulations with specific emphasis on Medicare clinical and billing guidelines.
- Work with physicians, nursing, and Center staff to insure appropriate and cost efficient ancillary utilization. Responsible for reviewing and insuring accuracy of all Medicare and ancillary billing for Medicare residents.
- Monitor medical records to assure the documentation reflects the skilled services provided and complies with policies and regulations. Assess residents'' needs and services and the overall PPS process to maximize utilization of Medicare and determine skilled coverage. Monitor residents'' awareness of ending coverage, including an appropriate denial letter and transfer notification. Monitor resident status within a thirty (30) day window of last covered day for skilled services. Monitor MDS''s to assure clinical accuracy and timely completion and transmission.
PHYSICAL DEMANDS AND ENVIRONMENT:
- Frequent walking, reaching, climbing, bending, lifting, grasping, fine hand coordination, pushing,
- Must be capable of performing the Essential Job Functions of this position with or without
- Must be able to relate positively and favorably to residents, families, and outside agencies and to
work cooperatively with other associates.
- Ability to present to groups.
- Ability to remain calm under stress.
- Ability to communicate with local staff, remote staff, and outside agencies.
- Understand, comply with, and promote rules regarding residents'' rights.
- Maintain an orderly, confidential, and safe work environment.
- Maintain professional competence through participation in continuing education programs,
seminars, and training programs.
- Develop positive relationships on behalf of the company with government regulators, families,
the area health care community, and the community at large. Play an active role in carrying out
the Center marketing plan.
- Adhere to all Company and departmental policies and procedures.
- Perform other duties as assigned.
- Must hold a current and valid nurse license in the state employed.
- Minimum of at least six (6) months'' experience completing MDS''s. Prefer minimum of three (3) years'' experience in nursing.
- Completion of post-secondary education and be able to read, write, and follow oral and written directions.
- Must be capable of maintaining regular attendance as required.
- Must meet all local health regulations and pass post-employment exam, if required.
- Related administrative experience at a level necessary to accomplish this position.