Registered Nurse Assessment Coordinator (RNAC)

About the Role

The RAI Coordinator ensures compliance with federal regulations through the timely completion of OBRA and Medicare assessments. This role oversees the Prospective Payment System (PPS) Minimum Data Set (MDS) process, including completion, submission, and corrections, while integrating services from nursing, dietitians, therapeutic recreation, restorative, rehabilitation, and physicians to capture all clinical conditions accurately.

Responsibilities

• Oversee and track the PPS MDS assessment process, including completion, submission, and corrections.
• Integrate interdisciplinary services (nursing, dietitian, therapeutic recreation, restorative, rehabilitation, and physician) to ensure accurate assessments.
• Confirm payer sources for all residents per HIQA.
• Ensure accurate and timely completion of all MDS assessments, including OBRA and Medicare PPS.
• Maintain an accurate schedule of MDS assessments with proper reference dates throughout the resident’s stay.
• Submit MDS assessments electronically, verify submissions, and perform corrections as needed.
• Coordinate interdisciplinary participation in completing MDS assessments within regulatory time frames.
• Ensure completeness and thoroughness of MDS documentation per federal and state standards.
• Schedule resident care conferences in compliance with regulations and ensure MDS reviews are completed prior to conferences.
• Assist disciplines with the care planning process, ensuring timely MDS completion, thorough CAA analysis, and team readiness for care conferences.
• Ensure Medicare documentation follows federal and state guidelines, including physician certification/recertification and non-coverage letters for Medicare Advantage.
• Monitor activities of daily living for accuracy and provide education when necessary.
• Conduct daily PPS meetings, weekly Medicare/Insurance meetings, and Quarterly Clinical Review meetings.
• Coordinate the monthly billing process, including triple check meetings, attested billing reports, and HMO logs.
• Assist with the appeal process to meet timelines and submit appeals.
• Coordinate the managed care process, including timely updates and obtaining ongoing authorizations.
• Ensure timely completion of Medicaid Picture Date submissions.