RACHEAL HALL
Summary
- Knowledgeable LPN, RAC-CT with 13+ years experience in clinical reimbursement. Detail-oriented, organized and friendly professional with high ethical standards. Motivated to use my expertise in order to contribute to company success.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Director of Clinical Reimbursement
Premier Genesee CNR
08.2017 - Current
- In charge of conducting and coordinating development and completion of MDS in accordance with current federal, state and local standards, guidelines and regulations.
- Complete thorough chart review prior to and upon admission for PDPM projection including ICD-10 coding and sequencing.
- Manage Medicare HMO plans by submitting clinical updates for continued stay authorizations, issue NOMNC's and SNF ABN's per CMS guidelines and handle all Livanta appeals.
- Maximize PDPM case mix through chart review, IDT meetings and strategic scheduling and coordination.
- Monitor and collect all supportive documentation to justify each CMG score received.
- Develop resident's plan of care based on Care Area Analysis and attend care plan conferences with IDT, residents and family.
- Transmit completed records to CMS, pull and analyze all iQies reports and update the 802 report for survey.
- Attend IDT meetings and manage the weekly Utilization Review meeting.
- Provide guidance to nursing staff on accurate completion of Section GG assessments, enhancing overall documentation quality and supporting appropriate Medicare/Medicaid reimbursement rates.
- Conduct audits of current MDS records to identify discrepancies and improve record accuracy, enhancing reimbursement rates for the facility.
- Identify areas of improvement in the facility''s quality measures through thorough analysis of MDS data, resulting in targeted interventions, better outcomes for residents and a significant improvement in our rating.
- Reduce hospital readmissions with proactive monitoring and intervention for residents at high risk.
- Advanced personal knowledge of MDS regulations and best practices through continuing education and professional development activities.
- 100% OMIG audit scores and no care plan or MDS related deficiencies.
MDS Coordinator
We Care, HCC
12.2023 - 12.2024
- Set schedules for staff to start and complete MDS assessments and care plan meetings.
- Ensured timely completion of all MDS assessments, maintaining full compliance with federal and state regulations.
- Maintained up-to-date knowledge on CMS guidelines and changes to ensure accuracy in reporting and reimbursement processes.
- Collaborated closely with therapy departments to accurately capture rehabilitation needs within MDS documentation, supporting appropriate resource allocation for residents'' needs.
- Assessed electronic medical record for required documentation to support MDS coding.
- Established regular review processes to evaluate the accuracy and completeness of MDS records, leading to proactive identification of potential issues before they escalate.
- Led weekly utilization review to go over recent clinical activities.
- Provided guidance to nursing staff on accurate completion of Section GG assessments, enhancing overall documentation quality and supporting appropriate Medicare/Medicaid reimbursement rates.
- Conducted audits of current MDS records to identify discrepancies and improve record accuracy, enhancing reimbursement rates for the facility.
- Complied with federal and state regulations for completion and coordination of RAI process.
MDS Coordinator
The Villages Of Orleans
10.2014 - 08.2017
- In charge of conducting and coordinating development and completion of MDS in accordance with current federal, state and local standards, guidelines and regulations.
- Completed all COT, EOT and PPS assessments per federal and local standards.
- Conducted all ADL training
- Developed resident's plan of care based on Care Area Analysis as well as attend care plan conferences with residents and families.
- Transmit completed records to CMS and, pull and analyze all Casper reports and update 672 and 802 records.
- Attended all IDT meetings and ran weekly UR meeting.
- Managed Medicare HMO and MLTC plans by submitting clinical updates for continued stay authorizations, issued all NOMNC's and SNF ABN's per CMS guidelines and was in charge of all appeals.
- Case mix increased from 0.96 to 1.37
- Held many ADON responsibilities such as managing staff, infection control, monitoring and tracking all fall and skin issues, conducting chart audits, in-servicing staff, and updating policy and procedures.
- No MDS, care plan deficiencies and 100% OMIG audit score.
MDS Coordinator
MDS Specialists, Inc.
08.2011 - 10.2014
- In charge of conducting and coordinating development and completion of MDS in accordance with current federal, state and local standards, guidelines and regulations.
- Received specific CMI training to ensure highest possible reimbursement.
- Completed all resident interviews necessary to complete MDS in its entirety.
- Integral member of IDT team; attended all meetings and was in charge of UR and care plan meetings.
- Completed all triggered CAA's and care plans.
- Responsible for managing and completing all COT's, EOT's and PPS assessments.
Education
Practical Nursing Diploma - Licensed Practical Nursing
MedVance Institute
Stuart, FL08.2008
Associate of Science - Health Studies
Monroe Community College
Rochester, NY 05.2003
High School Diploma -
Mt. Morris Central School
Mt. Morris, NY06.2000
Skills
- Patient Driven Payment Model
- Case Mix Index
- ICD-10 Coding
- Medicare Appeals
- Utilization / Case Management
- Care Planning
- SNF Chart Review
- Quality Measures
Certification
- BLS/CPR & First Aid, American Health Care Academy, Expires December 2025
- ICD - 10 Coding Training, February 2025
- Resident Assessment Coordinator (RAC-CT), AANAC, April 2016
- Infection Control Certification for New York State, September 2014
- Dementia Training Certification, October 2010
Additional Information
- Licensed Practical Nurse in the State of New York, License No - 320417.
Timeline
MDS Coordinator
We Care, HCC
12.2023 - 12.2024
Director of Clinical Reimbursement
Premier Genesee CNR
08.2017 - Current
MDS Coordinator
The Villages Of Orleans
10.2014 - 08.2017
MDS Coordinator
MDS Specialists, Inc.
08.2011 - 10.2014
Practical Nursing Diploma - Licensed Practical Nursing
MedVance Institute
Associate of Science - Health Studies
Monroe Community College
High School Diploma -
Mt. Morris Central School
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