Case Mix Specialist

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POST DATE 9/1/2016
END DATE 12/19/2016

Cynet Systems Seattle, WA

Seattle, WA
AJE Ref #
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Full Time
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We are looking for Case Mix Specialist for our client in Seattle, WA

Job Title: Case Mix Specialist

Job Location: Seattle, WA

Job Type: Full Time

Job Description:

* Required Case Mix Specialist
* Responsible to review Medicare/Medicaid documentation to assist nursing centers in completing MDS 3.0 documentation to assure appropriate levels of Medicare and/or Medicaid reimbursement.


* Reviews MDS 3.0 documentation for accuracy and appropriateness; Audits resident's chart to monitor that services match resident needs and documentation reflects categories for case mix reimbursement.
* Monitors LTCQ reports for accuracy of MDS coding.
* Monitors and assists with validation of Quality Indicator reports for accuracy of MDS coding.
* Responsible for accuracy of MA Picture Date process for each assigned center.
* Assists Director, Case Mix Reimbursement with developing training materials for quarterly MDS training sessions.
* Presents information at quarterly MDS training sessions.
* Monitors that facilities follow Medicare/Medicaid regulatory and HCR ManorCare reimbursement guidelines.
* Assists nursing staff in improving MDS assessment skills through formal and informal training.
* Coordinates training and communication with Clinical Services staff as needed.
* Performs audits per company and divisional standards and policies. Reviews required documentation tools; for example, RUG III Billing Log, to ensure appropriate levels of reimbursement.
* Monitors Corporate Compliance policies and notifies appropriate facility, regional, divisional, and corporate staff as needed.
* Attends and participates as needed in regional meetings, scheduled in-service programs, staff meetings and other center meetings and sits on required committees.
* Participates in assisting facility staff with interview of ADON of Clinical Documentation and MDS Coordinator.
* Participates in developing and updating Medicare PPS and Case Mix policies and procedures.
* Completes and maintains records and reports as required.
* Coordinates and promotes work between departments;
* Maintains confidentiality of necessary information.
* Collaborates with corporate and/or facility staff related to denial issues affected by the MDS.
* Works with facility, corporate and regional support staff to assure appropriate levels of reimbursement.
* Monitors submission requirements according to Federal and State standards.
* Monitors to assure the complete and timely submission of MDS data according to Federal and State reimbursement requirements.
* Collaborates with the facility to keep them informed of new developments for Federal and State payment systems.
* Remains abreast of regulatory change for Medicare/Medicaid reimbursement and communicates necessary information to appropriate personnel.
* Communicates and coordinates the resolution of facility issues through appropriate regional and corporate departments.
* Performs any miscellaneous work assignments as may be required.

Educational Requirements:

* Registered Nurserequired

Position Requirements:

* RN License Required.
* Three to five years previous MDS experiencepreferred;
* Strong management and interpersonal skills;
* Case Mix experience recommended;
* Computer literate and proficient with applications in the clinical area.
* Travel to Colorado also required.
* The position supports six Washington facilities and two facilities in Colorado.


* 2+ to 5years experience
* Management ExperienceRequired - No
* Minimum Education - Associate's Degree
* Willingness to Travel - Always


* Does the candidate have an RN license
* Does the candidate have MDS experience