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Position:  LPN/ RNAC Office

Reports to:  RNAC

Location: St. Barnabas Nursing Home/ Valencia Woods Nursing Center

Job Summary:  Responsible for assisting with administration, planning, operations, and development of the RNAC Department.  Manages and directs staff in the reimbursement issues related to the provision of clinical services to residents.  Manages and directs staff to be the resident advocate while incorporating federal guidelines and facility policies.  In conjunction with administration establishes and ensures regulatory compliance with Medicare, Medicaid, and other third party payer sources.

LPN/RNAC Essential Functions:

  1. Directs and assesses the scheduling and completion of patient’s MDSs within the regulatory and reimbursement guidelines.
  2. Supervises weekly interdisciplinary team meeting to formulate care plans, discuss progress, and evaluate effectiveness of interventions; and regularly conducts family care conferences.
  3. Reviews nursing documentation practices for clarity, conciseness, and consistency with resident needs, goals, and payer expectations.
  4. Organizes the tracking and analysis of RUG groupings for PPS billing, CMI reports, Quality Indicators and Quality Measures. Reviews outcome information with administration and facility personnel in order to take action on opportunities to improve.
  5. Demonstrates a good working knowledge of Medicare and other reimbursement regulations in relation to regulations and reimbursement and their effects on operational concerns.
  6. Completes and delivers all insurance denial letters.
  7. Holds staff accountable to SBHS’s policies, procedures and practices.
  8. Attends and participates in meetings. Exhibits follow through with communication new policies and procedures.
  9. Coordinates regulatory and reimbursement related educational activities for RNAC and Nursing Staff.
  10. Participates in quality improvement activities to ensure compliance with regulatory standards.
  11. Exhibits courtesy, compassion, and respect to residents, families, visitors, physicians, administration and co-workers.
  12. Monitors and ensures the proper completion of certificate of medical necessity forms.
  13. Complete insurance inquiries as necessary.
  14. List and code all diagnosis for new admissions.
  15. Weekly transmissions to the state for MDSs.
  16. Oversee and/ or complete the tracking of resident statistics.
  17. Other duties as necessary or appropriate when directed by RNAC or Administration.

Additional Responsibilities:  The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified and shall not be considered as a detailed description of all the work requirements that may be involved in the position.

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