MDS LPN
: Job Details :

DescriptionWe have an opening for an MDS LPN within our Taconic Healthcare Group!ESSENTIAL DUTIES AND RESPONSIBILITIES:• Provides education and assistance to facilities on Medicare/Medicaid related areas including eligibility,certification, coverage, documentation, utilization and reimbursement. Assists facilities with initialcertification procedures and follow-up of problem areas.• Interacts with Medicare, Managed Care and Medicaid claims review unit and compliance unit to assist afacility in complying with company procedures and federal, state and local regulations. Reports regularlyto administration on issues and activities. Interacts with the Medicare and managed Care intermediariesin areas of coverage and documentation. Assists in review and preparation of denied claims oradministrative record reviews by outside intermediaries.• Completes and assesses compliance with Medicare, Managed Care, Medicaid and third party payers andcompany procedures. Establishes systems and programs designed to correct any non-compliancesituation. Participates with any outside reimbursement audits to acquire first-hand knowledge of areasthat might lead to system failures.• Establishes and maintains current statistical data associated with the Medicare, Managed Care andMedicaid programs by region. Cooperates with operations to monitor activities for contractor programs,i.e. therapies, utilization review. Reviews and maintains Medicare, Managed Care and Medicaidreference materials.• Monitors and identifies utilization issues. Establishes systems and programs to maximize utilization andreimbursement. Monitors compliance with third party policies and procedures for authorizations forpayment and provision of services.• Provides ongoing orientation and training to appropriate facility staff regarding the Medicare, ManagedCare and Medicaid and other contracted third party payers. Provides education regarding changes in anyreimbursement program.• PDPM reviews upon admission or re-admission or as indicated• Review of MDS completion for Medicare A MDS' for compliance and accuracy• Gathers documentation for CMS audit requests and other audits as indicated• Reviews physician documentation for accurate ICD 10 coding, assisting to set and rank diagnosis for newadmissions and re-admissions• MDS Integrity reviews as indicated.• MDS completion as needed• Other duties as assignedStarting rate: $35 hourly#HOPHPEqual Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)