Simone Bove Burton
Summary
Knowledgeable CMAC eager to contribute to company success through hard work, attention to detail, and excellent organizational skills. Clear understanding of MDS with extensive training in PDPM, case mix, quality measures, and SNF regulations. Motivated to advance career after working in MDS 14+ years and achieving the level of training and knowledge necessary to excel further in the field of clinical reimbursement.
Overview
14
14
years of professional experience
Work History
MDS Coordinator / Director
Avalon Healthcare
09.2019 - Current
- In charge of conducting and coordinating the development and completion of resident assessment / MDS in accordance with current federal, state and local standards, guidelines and regulation.
- Complete Care Area Analysis (CAA) process and develop resident's plan of care based on findings, as well as attend care plan conferences with residents and families.
- Transmit completed records to CMS, pull and analyze different Casper reports and update 672 and 802 reports for survey.
- Attend all IDT meetings and run weekly UR meeting. Complete weekly UR report and submit it to our corporate office.
- Manage all Medicare HMO plans by submitting clinical updates for continued stay authorizations, issue all NOMNC's and SNF ABN's per CMS guidelines and handle all appeals.
- Conduct all ADL training with staff on a quarterly basis and as needed to ensure understanding and documentation compliance.
- Complete thorough review of resident's medical record prior to and upon admission in order to obtain PDPM projection, complete ICD-10 coding and sequencing, ensure proper GG documentation, and strategically schedule 5 Day or IPA to ensure highest possible reimbursement.
- Complete end of month billing trackers and triple check process with DOR and BOM to accurately release billing to our corporate office.
MDS Coordinator
HCR Manorcare
08.2010 - 01.2023
- Deliver full MDS support and education to clients in various facilities.
- Provide phone and zoom meeting support to help achieve positive outcomes from CMI and UR meetings, as well as conduct employee training in many areas such as ADL's, supportive documentation, therapy referrals, etc.
- Conduct MDS audits to ensure coding accuracy, case mix and PDPM maximization and that supportive documentation is in place for each CMG / RUG score.
- Provide detailed reports and spreadsheets to facility and corporate leaders.
- Help analyze 5 Star and Casper reports in order to improve quality measures, track MDS timely completion and missing assessments, and ensure no loss of revenue.
- Improve facility reimbursement, coding accuracy, and supportive documentation.
Education
Bachelor of Science - Nursing
Chamberlain College of Nursing
Chicago, IL05.2009
Associate of Applied Science - RN
Central Ohio Technical College
Newark, OH06.2007
Skills
- ICD-10 Coding
- Care Planning
- Quality Measures
- Patient Driven Payment Model (PDPM)
- Case Mix
- Medicare
- Medicaid
- ADL Coding
Additional Information
- RN Licensure in CA, WA, NY, CO ( compact RN license )
Timeline
MDS Coordinator / Director
Avalon Healthcare
09.2019 - Current
MDS Coordinator
HCR Manorcare
08.2010 - 01.2023
Bachelor of Science - Nursing
Chamberlain College of Nursing
Associate of Applied Science - RN
Central Ohio Technical College
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