Compliance Reimbursement Nurse (MDS) RN or LPN

Essential Functions

• Possess a thorough understanding of all regulations and standards related to the RAI process (Federal regulations and MDS User Manual)
• Remain knowledgeable of CMS coverage and payment methodologies, current Medicare/Medicaid regulations and documentation requirements
• Completes routine clinical review that thoroughly reviews resident’s medical records to verify that billing accurately reflects the care provided applying guidelines from the Medicare and Medicaid Services (CMS) and payer-provider contract terms to identify potential overpayments or underpayments
• Document audit findings clearly and precisely, often using proprietary workflow systems
• Provides feedback to center Administrator regarding issues identified and being addressed
• Educate MDS Coordinators on audit findings to ensure compliance and integrity of the RAI process
• Notifies staff or therapy of any changes that need to be made to documentation or workflow and follow-up to see that work is completed
• Works collaboratively with home office leadership, and center leadership to respond to routine compliance audits
• Works collaboratively with center Billers and therapy in review of records subject to external audits such as RAC audits and in oversight of coding of records for billing
• Maintain proficiency in the operations of the MDS software program, including the ability to transmit data per regulatory standards
• Identify trends in compliance audits that require company policy and procedure improvement with companywide education working with Vice President of Reimbursement and Corporate Compliance Officer to implement

Qualifications

• Graduate of an accredited School of Nursing
• LPN/RN with a current, active state license
• IDC-10 coding experience required
• MDS experience required
• Basic computer knowledge
• Excellent written, verbal, and interpersonal skills
• Exhibit excellent customer service and a positive attitude
• Convey compassion and empathy for residents and their representatives
• Be a skilled communicator, educator, director, and motivator
• Have exceptional organizational and time management skills
• Be committed to excellence
• CPR certified