Clinical Reimbursement Specialist/MDS Coordinator Resume

PROFESSIONAL SUMMARY:

Registered Nurse with19 years of clinical nursing experience and management expertise. Including MDS Coordinator, Clinical Reimbursement Specialist in Medicare, Medicaid, and Managed Care. Case Management from preadmission to discharge. Utilization review for therapies, documentation and medication. Clinical documentation review and audits. Staffing management. I have a strong reputation for driving top - quality Confidential t care within the guidelines of managed care reimbursement. I have excellent communication skills and my coworkers have described me as hard working, organized, and reliable.

TECHNICAL SKILLS:

Skills: Clinical Reimbursement SpecialistCertified Nurse Executive Case Management ExpertiseICD - 10 coding Utilization ReviewDocumentation review and audits Multiple EHR proficient MDS per RAI/SOM guideline

PROFESSIONAL EXPERIENCE:

Confidential

Clinical Reimbursement Specialist/MDS Coordinator

Responsibilities:

Initiated and manage Medicare, Medicaid and Managed Care benefits. Case Management from preadmission to discharge. Utilization review for therapy necessity, documentation and medication. Assessment planning per MDS/SOM guidelines, ICD 9 & 10 coding, documentation reviews and audits, Med A and Managed Care billing. Lead Interdisciplinary Care Team in Utilization Review, Care Planning, Quality Measures and Case Mix. Corporate, State, and Federal reporting. Proficient with Electronic Medical Health Records.

Confidential

Clinical Reimbursement Specialist

Responsibilities:

Collaborated, assessed and completed MDS schedule per RAI guidelines for 100-bed facility

Confidential

LPN Charge Nurse

Responsibilities:

Resident care of skilled and long-term residents. Facilitate documentation and communication with physicians, nurses, hospice, and other vendors. Administration of medications and treatments as ordered. Wound care, respiratory care, admission and discharges.

Confidential

Clinical Reimbursement Specialist/MDS Coordinator

Responsibilities:

Initiated and managed Medicare skilled benefits, Case management for Medicare/Medicaid benefits. Diagnosis coding, documentation audits, and medication reviews. Admission and discharge planning. Lead Interdisciplinary Care Team Utilization Review, Quality Measures and Case Mix.

Confidential

LPN Charge Nurse

Responsibilities:

Resident care of skilled and long-term residents. Facilitate, documentation and communication with physicians, nurses, hospice, and other vendors. Administration of medications and treatments as ordered. Wound care, respiratory care, admission and discharges.

Confidential

LPN Charge Nurse/Interim Unit Coordinator

Responsibilities:

Full-time charge nurse. Duties included: Med pass, treatments, assessing residents, vital signs, admissions, scheduling and planning of out Confidential t appointments, discharges, end-of-life care, skilled Med A guidelines, care plans, documentation, physician communication, family interactions, long term care, supervising staff.

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