Manager Services
Resume:
Tiezo D. Adkison, RAC-CT, CNAC, LVN, LTCM-C
**** ****** ****, ***. **** Dallas, Texas 75214
*****.*******@*****.***
Skills Objective: To Secure a position as a Regional Consultant within a thriving Long Term Care Corporation. To be afforded the opportunity to utilize past years of experience in management, nursing, billing and more recently Minimum Data Set trends to empower facility administration and staff with reimbursement and compliance power.
Clinical Reimbursement Coordinator January 2009 – May 2012
Founders Plaza Health and Rehab Wylie, Texas
• Maintain Medicare reimbursement for 90 bed facility.
• Medicare and Medicaid reimbursement processing
• Clinical documentation audits to support
• Educate train nurses on how to and what to document
• Clinical educator
• Medicare ADR processing and responses for unpaid claims
• Research gaps in payment for both Medicare, managed care and Medicaid
• Transmit clinical data to QIES ASAP system
Director of Clinical Reimbursement Services February 2009 – October 2011
Remington Medical Resorts – Richardson Richardson, Texas
• Maintain Medicare reimbursement for 90 bed facility.
• Coordinate all IDT Care plan meetings to include family, resident and primary physician to address any plan of care concerns with new Medicare admissions.
• Optimize RUG Levels by gathering all necessary information from acute care hospital, restorative nursing, Part B Therapy, MARS and TARS. Coordinate PPS meeting with rehab daily and weekly with rehab, social services and BOM.
• Verify Skilled Nursing Facility benefits coverage with Medicare and other private insurance companies.
• Verify Common Working File accuracy.
• Consult with guest in the resort on benefits and question about their SNF stay.
• Complete and transmit MDS assessments to CMS via VPN portal
• Audit and maintain Skilled Nursing for Medicare Part A coverage guidelines
• Work closely with Clinical Services and Case Management to ensure adequate documentation to substantiate reimbursement.
• Consult with sister resort staff to ensure companywide compliance with Medicare PPS regulations.
Regional Resource Utilization Specialist September 2010 – August 2011
Life Care Centers of America Cleveland, TN
• Manage all Medicaid/ Medicare reimbursement in 8 SNF facilities in Texas.
• Analyze ADL scores in each facility in comparison with acuity report.
• Assist each facility with optimizing RUG Levels by gathering all necessary information from acute care hospital, restorative nursing, Part B Therapy, MARS and TARS. Coordinate PPS meeting with rehab daily and weekly with rehab, social services and BOM.
• Submit and view pending denials and LTCMI forms via the online TMHP Portal.
• Extensive travel across state of Texas.
• Work with MDS Coordinators and train on MDS 2.0 to 3.0 transition.
• Assist administrator, BOM and Rehab director with understanding the MDS and how it reflects reimbursement rates.
• In service nurses and nurse assistant on accurate charting to substantiate reimbursement
• Manage Medicare Reimbursement Services and all ADR request from fiscal intermediary
Clinical Reimbursement Coordinator February 2009 – March 2010
Millennial Care Corporation Plano, Texas
• Manage all Medicaid reimbursement in multiple facilities.
• Coordinate all IDT Care plan meetings to include family, resident and primary physician to address any plan of care concerns with new Medicare admissions.
• Optimize RUG Levels by gathering all necessary information from acute care hospital, restorative nursing, Part B Therapy, MARS and TARS. Coordinate PPS meeting with rehab daily and weekly with rehab, social services and BOM.
• Submit and view pending denials and LTCMI forms via the online TMHP Portal.
• Batch and submit MDS’s via simple CFS Software.
• Submit old 3652 Purpose Code E’s to recoup revenue
• Work closely with social services and family with residents applying for Medicaid
• In service nurses and nurse assistant on accurate charting to substantiate reimbursement
• Manage Medicare Reimbursement Services and all ADR request from fiscal intermediary
Clinical Reimbursement Coordinator August 2008 – February 2009
Willow Bend Nursing & Rehab. Dallas, Texas
• Manage all Medicare and Medicaid reimbursement via PPS assessments and RUG assessments.
• Coordinate all IDT Care plan meeting to include family, resident and primary physician to address any plan of care concerns with new Medicare admissions.
• Optimize RUG Levels by gathering all necessary information from acute care hospital. Coordinate PPS meeting with rehab daily and weekly with rehab, social services and BOM.
• Manage restorative nursing team so capture restorative nursing services on MDS assessment.
• In-service and train staff on Medicare/ Medicaid guidelines to support actual patient care, then secondly the MDS assessment.
• Manage daily CNA and Nursing charting of ADL’s and documentation to support skilled level of care.
• Transmit and validate MDS via Simple CFS portal
• Triple check at month end to validate billing with BOM, DOR, Administrator, Medical Records and Social Services.
• Daily PPS Meeting with BOM, Social Services and DOR to review current level of care ARD and diagnosis codes.
Regional Clinical Reimbursement Consultant November 2006 – March 2008
Daybreak Venture Ft. Worth/ Stanton, Texas
• Prescreen all potential Medicare Part A or Managed Care payor source patients to be admitted to facility for extensive groupers and/or determine levels of care needed for billing.
• Track days used, exhaustion of benefits and break in illness spell during facility stay, after discharge from facility or from skilled rehabilitation services.
• Coordinate all Care Plans on new admits within the 21 day time period stated in regulations. Work closely with family and Interdisciplinary team to develop care plan that is patient centered and measurable.
• Audit Medicare and Medicaid charting daily along with monthly in-services to nursing staff on how to capture items on the MDS such as behaviors, toileting, wound and respiratory treatments or other skilled nursing care.
• Educate patient, family and other staff members on the guidelines of Medicare Part A stay while in the facility, services covered, co-pays and out of pocket expenses and any additional concerns expressed by patients.
• Input MDS into American Health Tech System and submit to CMS via secure AT& T portal. Audit missing MDS report generated by CMS monthly and research MDS and provide resolution to corporate office.
• Complete triple check for month end which entailed physician’s certification completion, transmitted MDS’, initial order on chart and rehabilitation services completed and signed 702 before business office would be permitted to bill.
• Optimize RUG levels by carrying extensive groups when permitted on the 5 and 14 day MDS to cover until day 30. Work closely with Rehab. Director daily to assess status and tolerance of patients on rehab to optimize rehabilitation potential and reimbursement.
Medicaid Biller/ Trust Fund Manager February 2003 – Sept 2005
Bishop Davies Nursing and Rehab Hurst, Texas
• Manage all Medicaid billing for skilled nursing facility and hospice.
• Coordinate trust fund transactions including disbursements, deposits and reconciliation of the account.
• Coordinate ancillary charges input into system and manage patient billing statements monthly.
• Perform collection calls on past due accounts as needed
• Bill private insurance companies for payments in SNF and research unpaid claims.
• Perform month end close on books for entire facility in timely manner.
• Work closely with TILE Nurse to ensure that MESAV’s reflect accurate level of care for billing.
EDUCATION
Vocational Nursing Diploma December 2006
Concorde Career Institute- Arlington, Texas
Certified Nurse Assessment Coordinator October 2007
NASPAC – Washington, DC
Resident Assessment Coordinator-Certified October 2008
AANAC
Long Term Care Manager Certified March 2010
AANAC
REFERENCES
Salil Gokhale, OTR
Victoria Hill, RD, LD
Brad Wisner, LMSW
Romona Few, RN, BSN, MS
Todd Mackenzie, LNFA, MS
Tiezo D. Adkison, RAC-CT, CNAC, LVN, LTCM-C
6418 Fisher Road, Apt. 206B Dallas, Texas 75214
*****.*******@*****.***
Skills Objective: To Secure a position as a Regional Consultant within a thriving Long Term Care Corporation. To be afforded the opportunity to utilize past years of experience in management, nursing, billing and more recently Minimum Data Set trends to empower facility administration and staff with reimbursement and compliance power.
Clinical Reimbursement Coordinator January 2009 – May 2012
Founders Plaza Health and Rehab Wylie, Texas
• Maintain Medicare reimbursement for 90 bed facility.
• Medicare and Medicaid reimbursement processing
• Clinical documentation audits to support
• Educate train nurses on how to and what to document
• Clinical educator
• Medicare ADR processing and responses for unpaid claims
• Research gaps in payment for both Medicare, managed care and Medicaid
• Transmit clinical data to QIES ASAP system
Director of Clinical Reimbursement Services February 2009 – October 2011
Remington Medical Resorts – Richardson Richardson, Texas
• Maintain Medicare reimbursement for 90 bed facility.
• Coordinate all IDT Care plan meetings to include family, resident and primary physician to address any plan of care concerns with new Medicare admissions.
• Optimize RUG Levels by gathering all necessary information from acute care hospital, restorative nursing, Part B Therapy, MARS and TARS. Coordinate PPS meeting with rehab daily and weekly with rehab, social services and BOM.
• Verify Skilled Nursing Facility benefits coverage with Medicare and other private insurance companies.
• Verify Common Working File accuracy.
• Consult with guest in the resort on benefits and question about their SNF stay.
• Complete and transmit MDS assessments to CMS via VPN portal
• Audit and maintain Skilled Nursing for Medicare Part A coverage guidelines
• Work closely with Clinical Services and Case Management to ensure adequate documentation to substantiate reimbursement.
• Consult with sister resort staff to ensure companywide compliance with Medicare PPS regulations.
Regional Resource Utilization Specialist September 2010 – August 2011
Life Care Centers of America Cleveland, TN
• Manage all Medicaid/ Medicare reimbursement in 8 SNF facilities in Texas.
• Analyze ADL scores in each facility in comparison with acuity report.
• Assist each facility with optimizing RUG Levels by gathering all necessary information from acute care hospital, restorative nursing, Part B Therapy, MARS and TARS. Coordinate PPS meeting with rehab daily and weekly with rehab, social services and BOM.
• Submit and view pending denials and LTCMI forms via the online TMHP Portal.
• Extensive travel across state of Texas.
• Work with MDS Coordinators and train on MDS 2.0 to 3.0 transition.
• Assist administrator, BOM and Rehab director with understanding the MDS and how it reflects reimbursement rates.
• In service nurses and nurse assistant on accurate charting to substantiate reimbursement
• Manage Medicare Reimbursement Services and all ADR request from fiscal intermediary
Clinical Reimbursement Coordinator February 2009 – March 2010
Millennial Care Corporation Plano, Texas
• Manage all Medicaid reimbursement in multiple facilities.
• Coordinate all IDT Care plan meetings to include family, resident and primary physician to address any plan of care concerns with new Medicare admissions.
• Optimize RUG Levels by gathering all necessary information from acute care hospital, restorative nursing, Part B Therapy, MARS and TARS. Coordinate PPS meeting with rehab daily and weekly with rehab, social services and BOM.
• Submit and view pending denials and LTCMI forms via the online TMHP Portal.
• Batch and submit MDS’s via simple CFS Software.
• Submit old 3652 Purpose Code E’s to recoup revenue
• Work closely with social services and family with residents applying for Medicaid
• In service nurses and nurse assistant on accurate charting to substantiate reimbursement
• Manage Medicare Reimbursement Services and all ADR request from fiscal intermediary
Clinical Reimbursement Coordinator August 2008 – February 2009
Willow Bend Nursing & Rehab. Dallas, Texas
• Manage all Medicare and Medicaid reimbursement via PPS assessments and RUG assessments.
• Coordinate all IDT Care plan meeting to include family, resident and primary physician to address any plan of care concerns with new Medicare admissions.
• Optimize RUG Levels by gathering all necessary information from acute care hospital. Coordinate PPS meeting with rehab daily and weekly with rehab, social services and BOM.
• Manage restorative nursing team so capture restorative nursing services on MDS assessment.
• In-service and train staff on Medicare/ Medicaid guidelines to support actual patient care, then secondly the MDS assessment.
• Manage daily CNA and Nursing charting of ADL’s and documentation to support skilled level of care.
• Transmit and validate MDS via Simple CFS portal
• Triple check at month end to validate billing with BOM, DOR, Administrator, Medical Records and Social Services.
• Daily PPS Meeting with BOM, Social Services and DOR to review current level of care ARD and diagnosis codes.
Regional Clinical Reimbursement Consultant November 2006 – March 2008
Daybreak Venture Ft. Worth/ Stanton, Texas
• Prescreen all potential Medicare Part A or Managed Care payor source patients to be admitted to facility for extensive groupers and/or determine levels of care needed for billing.
• Track days used, exhaustion of benefits and break in illness spell during facility stay, after discharge from facility or from skilled rehabilitation services.
• Coordinate all Care Plans on new admits within the 21 day time period stated in regulations. Work closely with family and Interdisciplinary team to develop care plan that is patient centered and measurable.
• Audit Medicare and Medicaid charting daily along with monthly in-services to nursing staff on how to capture items on the MDS such as behaviors, toileting, wound and respiratory treatments or other skilled nursing care.
• Educate patient, family and other staff members on the guidelines of Medicare Part A stay while in the facility, services covered, co-pays and out of pocket expenses and any additional concerns expressed by patients.
• Input MDS into American Health Tech System and submit to CMS via secure AT& T portal. Audit missing MDS report generated by CMS monthly and research MDS and provide resolution to corporate office.
• Complete triple check for month end which entailed physician’s certification completion, transmitted MDS’, initial order on chart and rehabilitation services completed and signed 702 before business office would be permitted to bill.
• Optimize RUG levels by carrying extensive groups when permitted on the 5 and 14 day MDS to cover until day 30. Work closely with Rehab. Director daily to assess status and tolerance of patients on rehab to optimize rehabilitation potential and reimbursement.
Medicaid Biller/ Trust Fund Manager February 2003 – Sept 2005
Bishop Davies Nursing and Rehab Hurst, Texas
• Manage all Medicaid billing for skilled nursing facility and hospice.
• Coordinate trust fund transactions including disbursements, deposits and reconciliation of the account.
• Coordinate ancillary charges input into system and manage patient billing statements monthly.
• Perform collection calls on past due accounts as needed
• Bill private insurance companies for payments in SNF and research unpaid claims.
• Perform month end close on books for entire facility in timely manner.
• Work closely with TILE Nurse to ensure that MESAV’s reflect accurate level of care for billing.
EDUCATION
Vocational Nursing Diploma December 2006
Concorde Career Institute- Arlington, Texas
Certified Nurse Assessment Coordinator October 2007
NASPAC – Washington, DC
Resident Assessment Coordinator-Certified October 2008
AANAC
Long Term Care Manager Certified March 2010
AANAC
REFERENCES
Salil Gokhale, OTR
Victoria Hill, RD, LD
Brad Wisner, LMSW
Romona Few, RN, BSN, MS
Todd Mackenzie, LNFA, MS
6418 Fisher Road, Apt. 206B Dallas, Texas 75214
*****.*******@*****.***
Skills Objective: To Secure a position as a Regional Consultant within a thriving Long Term Care Corporation. To be afforded the opportunity to utilize past years of experience in management, nursing, billing and more recently Minimum Data Set trends to empower facility administration and staff with reimbursement and compliance power.
Clinical Reimbursement Coordinator January 2009 – May 2012
Founders Plaza Health and Rehab Wylie, Texas
• Maintain Medicare reimbursement for 90 bed facility.
• Medicare and Medicaid reimbursement processing
• Clinical documentation audits to support
• Educate train nurses on how to and what to document
• Clinical educator
• Medicare ADR processing and responses for unpaid claims
• Research gaps in payment for both Medicare, managed care and Medicaid
• Transmit clinical data to QIES ASAP system
Director of Clinical Reimbursement Services February 2009 – October 2011
Remington Medical Resorts – Richardson Richardson, Texas
• Maintain Medicare reimbursement for 90 bed facility.
• Coordinate all IDT Care plan meetings to include family, resident and primary physician to address any plan of care concerns with new Medicare admissions.
• Optimize RUG Levels by gathering all necessary information from acute care hospital, restorative nursing, Part B Therapy, MARS and TARS. Coordinate PPS meeting with rehab daily and weekly with rehab, social services and BOM.
• Verify Skilled Nursing Facility benefits coverage with Medicare and other private insurance companies.
• Verify Common Working File accuracy.
• Consult with guest in the resort on benefits and question about their SNF stay.
• Complete and transmit MDS assessments to CMS via VPN portal
• Audit and maintain Skilled Nursing for Medicare Part A coverage guidelines
• Work closely with Clinical Services and Case Management to ensure adequate documentation to substantiate reimbursement.
• Consult with sister resort staff to ensure companywide compliance with Medicare PPS regulations.
Regional Resource Utilization Specialist September 2010 – August 2011
Life Care Centers of America Cleveland, TN
• Manage all Medicaid/ Medicare reimbursement in 8 SNF facilities in Texas.
• Analyze ADL scores in each facility in comparison with acuity report.
• Assist each facility with optimizing RUG Levels by gathering all necessary information from acute care hospital, restorative nursing, Part B Therapy, MARS and TARS. Coordinate PPS meeting with rehab daily and weekly with rehab, social services and BOM.
• Submit and view pending denials and LTCMI forms via the online TMHP Portal.
• Extensive travel across state of Texas.
• Work with MDS Coordinators and train on MDS 2.0 to 3.0 transition.
• Assist administrator, BOM and Rehab director with understanding the MDS and how it reflects reimbursement rates.
• In service nurses and nurse assistant on accurate charting to substantiate reimbursement
• Manage Medicare Reimbursement Services and all ADR request from fiscal intermediary
Clinical Reimbursement Coordinator February 2009 – March 2010
Millennial Care Corporation Plano, Texas
• Manage all Medicaid reimbursement in multiple facilities.
• Coordinate all IDT Care plan meetings to include family, resident and primary physician to address any plan of care concerns with new Medicare admissions.
• Optimize RUG Levels by gathering all necessary information from acute care hospital, restorative nursing, Part B Therapy, MARS and TARS. Coordinate PPS meeting with rehab daily and weekly with rehab, social services and BOM.
• Submit and view pending denials and LTCMI forms via the online TMHP Portal.
• Batch and submit MDS’s via simple CFS Software.
• Submit old 3652 Purpose Code E’s to recoup revenue
• Work closely with social services and family with residents applying for Medicaid
• In service nurses and nurse assistant on accurate charting to substantiate reimbursement
• Manage Medicare Reimbursement Services and all ADR request from fiscal intermediary
Clinical Reimbursement Coordinator August 2008 – February 2009
Willow Bend Nursing & Rehab. Dallas, Texas
• Manage all Medicare and Medicaid reimbursement via PPS assessments and RUG assessments.
• Coordinate all IDT Care plan meeting to include family, resident and primary physician to address any plan of care concerns with new Medicare admissions.
• Optimize RUG Levels by gathering all necessary information from acute care hospital. Coordinate PPS meeting with rehab daily and weekly with rehab, social services and BOM.
• Manage restorative nursing team so capture restorative nursing services on MDS assessment.
• In-service and train staff on Medicare/ Medicaid guidelines to support actual patient care, then secondly the MDS assessment.
• Manage daily CNA and Nursing charting of ADL’s and documentation to support skilled level of care.
• Transmit and validate MDS via Simple CFS portal
• Triple check at month end to validate billing with BOM, DOR, Administrator, Medical Records and Social Services.
• Daily PPS Meeting with BOM, Social Services and DOR to review current level of care ARD and diagnosis codes.
Regional Clinical Reimbursement Consultant November 2006 – March 2008
Daybreak Venture Ft. Worth/ Stanton, Texas
• Prescreen all potential Medicare Part A or Managed Care payor source patients to be admitted to facility for extensive groupers and/or determine levels of care needed for billing.
• Track days used, exhaustion of benefits and break in illness spell during facility stay, after discharge from facility or from skilled rehabilitation services.
• Coordinate all Care Plans on new admits within the 21 day time period stated in regulations. Work closely with family and Interdisciplinary team to develop care plan that is patient centered and measurable.
• Audit Medicare and Medicaid charting daily along with monthly in-services to nursing staff on how to capture items on the MDS such as behaviors, toileting, wound and respiratory treatments or other skilled nursing care.
• Educate patient, family and other staff members on the guidelines of Medicare Part A stay while in the facility, services covered, co-pays and out of pocket expenses and any additional concerns expressed by patients.
• Input MDS into American Health Tech System and submit to CMS via secure AT& T portal. Audit missing MDS report generated by CMS monthly and research MDS and provide resolution to corporate office.
• Complete triple check for month end which entailed physician’s certification completion, transmitted MDS’, initial order on chart and rehabilitation services completed and signed 702 before business office would be permitted to bill.
• Optimize RUG levels by carrying extensive groups when permitted on the 5 and 14 day MDS to cover until day 30. Work closely with Rehab. Director daily to assess status and tolerance of patients on rehab to optimize rehabilitation potential and reimbursement.
Medicaid Biller/ Trust Fund Manager February 2003 – Sept 2005
Bishop Davies Nursing and Rehab Hurst, Texas
• Manage all Medicaid billing for skilled nursing facility and hospice.
• Coordinate trust fund transactions including disbursements, deposits and reconciliation of the account.
• Coordinate ancillary charges input into system and manage patient billing statements monthly.
• Perform collection calls on past due accounts as needed
• Bill private insurance companies for payments in SNF and research unpaid claims.
• Perform month end close on books for entire facility in timely manner.
• Work closely with TILE Nurse to ensure that MESAV’s reflect accurate level of care for billing.
EDUCATION
Vocational Nursing Diploma December 2006
Concorde Career Institute- Arlington, Texas
Certified Nurse Assessment Coordinator October 2007
NASPAC – Washington, DC
Resident Assessment Coordinator-Certified October 2008
AANAC
Long Term Care Manager Certified March 2010
AANAC
REFERENCES
Salil Gokhale, OTR
Victoria Hill, RD, LD
Brad Wisner, LMSW
Romona Few, RN, BSN, MS
Todd Mackenzie, LNFA, MS
Contact this candidate