Experience

Covenant Dove, LLC

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Clinical Reimbursement Specialist, RN

  • Jul 2011 - Present

  Corporate consultant for Management Company with forty-eight facilities in eleven states. Responsibilities: Direct regional assignment for multi-state facilities; Providing support for other facilities within company; Teaching the ID team MDS 3, RUGS-IV and PPS; interview and hiring recommendations for MDS team members; coaching staff members; chart audits and reviews for ADR, RAC, PERM, CERT, and insurance requests; monitoring and approving Medicare cuts; completing and providing in-service training; teaching reimbursement strategies; provide guidance in MDS/PPS management for centers; review monthly RUGS prior to billing for logic; MDS transmission; review of all Medicare residents for billing accuracy in relation to RUGS, COT, EOT, SOT, scheduled assessment, payor status; review PointRight reports for MDS accuracy; review of planned discharges to ensure maximum benefit from skilled services has been met; review of therapy planning to ensure appropriate care and services for skilled residents; Implemented regional training in relation to COT assessments with a resultant decrease in default or provider liability days throughout that area Show less



Opis Senior Services Group

• United States
• Hospitals and Health Care
• 200 - 300 Employee

• Clinical Reimbursement MDS Manager

  • Jul 2007 - Jul 2011

  Corporate consultant for Management Company with eleven facilities throughout Florida. Responsibilities as above and additionally: negotiate accurate reimbursement levels with insurance companies, assisting with completion of Action Plans; writing Medicare and insurance appeals; compile monthly Medicare ALOS for company; troubleshoot clinical software issues – liaison for clinical support nurse at Software Company; provide guidance in MDS/PPS/ insurance management for centers, preparation of three day MDS 3.0/RUGS IV training program with training provided to team members throughout entire company prior to MDS 3.0 transition for successful transition and implementation; Initiation of ADL training program across all facilities to improve ADL scores and positively impact reimbursement; Part of PointClickCare configuration team with successful training and implementation across eleven facilities. Created care plan database and MDS trigger links. Provide initial and on-going training for clinical team; Headed successful transition from RUGS-III to RUGS-IV with no company default days Show less