Regional Reimbursement Consultant- Chicagoland Area

SUMMARY: The MDS Consultant is responsible for the accurate and timely completion of all Medicare/Medicaid case-mix documents in order to assure appropriate reimbursement for care and services provided within the Facilities. He/she will integrate nursing, dietary, social recreation, restorative, rehabilitation and physician services to ensure appropriate assessment and reimbursement.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Oversees the reimbursement processes over multiple facilities
• Audits routinely to ensure compliance
• Assesses and determines the health status and level of care of all new admissions.
• Ensures the accurate and timely completion of all MDS Assessments including PPS Medicare, quarterly, annual, significant change.
• Communicates level of care for new resident to all disciplines.
• Coordinates interdisciplinary participation in completing the Minimum Data Set (MDS) for each new admission to facility according to regulatory time frames. Ensures completeness and thoroughness of documentation as mandated by federal, state and medical standards.
• Maintains an accurate schedule of all MDS assessments to include the proper reference dates throughout the resident’s stay.
• Responsible for the data entry function to assure accurate data entry and electronic submission of MDS assessments.
• Verifies electronic submissions of MDS, performs corrections when necessary and maintains appropriate records.
• Coordinates interdisciplinary participation in completing the MDS for each resident according to regulatory time frames. Ensures completeness and thoroughness of documentation as mandated by federal and state standards.
• Schedules and conducts resident care conferences in compliance with state and federal regulations and ensures completion of all MDS reviews prior to resident care conference.
• Assists disciplines in formulating and revising care plans. Ensures that resident’s present/potential problems are identified and prioritized; realistic goals are established and nursing intervention is appropriate.
• Evaluates resident care plans for comprehensiveness and individuality.
• Assesses the achievement or lack of achievement of desired outcomes. Ensures that resident’s care plan is reassessed and revised appropriately.
• Responsible for all level of care changes within the facility. Notifies all departments when a level of care change has been made.
• Generates appropriate forms to complete level of acuity and changes. Transmits forms to the appropriate agency for processing as required by state law.
• Other duties as assigned.
  
  
  

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill, and/or ability required.

• Registered Nurse with current unencumbered state licensure
• Long Term Care Experience preferred.
• Ability to read, write, speak and understand the English language.
• Knowledgeable of Medicaid and Medicare processes and regulations
  
  
  

Ensures facilities following processes to ensure compliance with state and federal regulations

• Well versed in the RAI
• Must be an RN, BSN preferred with 3 to 5 years of experience
• Looking for a candidate who is adaptable and dependable
  
  
  

PHYSICAL DEMANDS: The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Required to sit, stand, bend and walk regularly; lift and/or move up to 25
• Visual and auditory ability sufficient for written and verbal communication.
• The noise level in the work environment is usually moderate.
• Not a remote position, there are remote days but will be spending 4 days a week in the facilities doing consultant visits