Duties and Responsibilities

Administer Patient Assessments

  • Coordinate patient care and administer patient assessments.
  • Oversee the assessment process, setting assessment schedules, review assessments and ensure that assessments are done in an accurate and timely manner.
  • Make policy and procedural recommendations to the upper level management staff.
  • Develop Care Planstransmits assessments to the Department of Health.
  • Coordinates the care plan as according to regulatory requirements.
  • Ensure that important resources are made available to patients and that patient care is delivered effectively and to a satisfactory standard.

Coordinate Medicare and Medicaid

  • Licensed RN/LPN in NJ preferred
  • Create schedules for all Medicare and Medicaid.
  • Start Medicare / Medicaid coverage for newly qualified patients or send out denial letters.
  • Stay updated on changes in Medicare coverage and help determine documents needed for Medicaid reimbursement.
  • Perform other duties as may be called upon by management.

Qualifications and Experience

  • Licensed RN/LPN preferred
  • Three (3) years of progressively responsible and directly related work experience.
  • Prior experience in MDS coordination or health information systems preferred.
  • 1-2 years of statistical analysis and medical billing experience.
  • Clinical experience in a healthcare setting or group home
  • Basic computer literacy
  • Working knowledge of MDS 3.0
  • Knowledge of State and Federal regulations
  • Knowledge of Resident Assessment
  • Long term care experience in a Group Home setting.

Working knowledge of government/non-government payer requirements, reimbursement rules, laws and regulations that govern billing/collection activities. Knowledge of CCI (Correct Coding Initiatives) and CMS compliance issues and clinical documentation, coding, third-party reimbursement), patient financial services (e.g., managed care contracting, claims processing, account resolution, denial management, payment posting).