PRIMARY DUTY

The overall purpose of the MDS/Care Plan Coordinator is to manage the integrity of the Facility Medicare/Medicaid Programs. This includes, but is not limited to: verification of eligibility, entitlement and coverage; completion of MDS/PPS and OBRA assessments; accurate and timely submission of all supporting documentation, as well as submission of reports timely to corporate for billing.

ESSENTIAL JOB FUNCTIONS include the following. Other duties may be assigned. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Conducts pre-admission nursing screenings as assigned; ensures Medicare Part A eligibility, entitlement and coverage criteria on all new facility admissions
• Obtains Medicare qualifying diagnosis for residents obtaining Medicare A services and updates diagnosis for each change in diagnosis
• Prepares, coordinates and maintains schedule of MDS and resident care plans for timely completion
• Initiates interim care plan on all admissions/readmissions
• Monitors residents for change in condition through facility meetings and ongoing interaction with staff regarding resident's status
• Ensures that resident care plans are updated as needed or indicated
• Coordinates weekly Medicare meetings for interdisciplinary team and family care plan conferences
• Assures preparation of Medicare denial letters for each resident discharged from Medicare coverage within time limits imposed by Medicare guidelines
• Coordinates the distribution of care plan conference invitations to residents and families
• Ensures electronic submission of MDS materials to the state regulatory agencies as directed
• Utilizes the web based electronic computer programs to monitor the Medicare/Medicaid programs within the facility
• Conducts in-service education programs regarding the MDS/Care Plan processes as assigned
• Tracks daily eligibility of residents for continued Medicare benefits
• Meets with therapists to report resident progress for those residents receiving direct therapy services under Part A or B Medicare services
• Responsible for oversight and evaluation of consistency of documentation, care plans, physician orders, etc. to ensure accurate reimbursement
• Ensures appropriate, accurate and timely completion of the physician certification/recertification form, SNF determination, and admission letter, SNF determination of continued stay, consent form (non-certified bed letter), beneficiary voluntary placement letter and Medicare secondary payer letter
• Maintains back up documentation folders for Medicaid program
• Monitors the facility Quality Indicator Report and submits this report to appropriate personnel as directed
• Monitors the appropriate MDS website for up to date changes in the instructional manual monthly and distributes changes in the instructional manual monthly and distributes changes to the interdisciplinary team as needed
• Understands and reviews the facility's Healthcare Clinical Policies and Procedures and Safety Guidelines
• Reports any issues or problems that may arise to the Director of Nursing and/or Administrator
• Complies with state, federal, and all other applicable health care and safety standards
• Performs other duties as directed

EDUCATION and EXPERIENCE an equivalent combination of education, training and experience will be considered.

• Graduate from an accredited nursing program; minimum of 2 years of previous long-term care experience; or an equivalent combination of education and experience
• Must be licensed in the applicable state as a Licensed Practical Nurse (LPN) or Registered Nurse (RN); Registered Nurse (RN) preferred
• Knowledge of RAI, Medicare and PPS processes required