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 Plans, transmits 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).