Reimbursement Specialist Case Manager
Resume:
JUDY G. EMBERS
VERNON, TEXAS *****
OBJECTIVE
SEEKING A FULL TIME POSITION AS A SKILLED, CONFIDENT, EDUCATED REGISTERED NURSE. LOOKING FOR A HEALTHCARE ORGANIZATION THAT WILL UTILIZE ARS OF EXPERIENCE. I AM INTERESTED IN POSITION THAT WILL UTILIZE MY EXPERIENCE IN THE CARE OF THE GERIATRIC PATIENTS, RESIDENTS OR CLIENTS WITH A POSITION THAT WILL FURTHER ENHANCE EXPERIENCE AND SKILLS WHETHER IN DIRECT PATIENT CARE, BILLING, OR MANAGEMENT POSITION.
QUALIFICATIONS/SKILLS
STRONG ORGANIZATIONAL SKILLS EFFECTIVE COMMUNICATOR WITH PROVEN RESULTS
EXCELLENT CLINICAL SKILLS STRONG LEADERSHIP, MENTOR QUALITIES
SOLID MEDICAL KNOWLEDGE PATIENT ADVOCATE
COMPUTER KNOWLEDGE DON/ADMINISTRATOR EXPERIENCED
HOME HEALTH EXPERIENCE MENTAL HEALTH, MEDICAL-SURGICAL EXPERIENCE
REIMBURSEMENT WITH MEDICARE AND MEDICAID SYSTEM (LTCMI)
Professional Experience: I have been in reimbursement for Long term care since 2008 as a Regional reimbursement consultant for long term care facilities and I been employed in a facility as the MDS/Reimbursement/ care plan coordinator. I am knowledgeable in all aspects of the MDS, RUG analysis, Case Mix Index, payment for Medicare and Texas Medicaid. I am knowledgeable in federal guidelines and Regulations of the RAI Process, Dad’s regulations for Texas, Medicaid guidelines and regulations based on the Texas Administrative Code (TAC), CMS as it relates to Texas Compliance and Regulations for reimbursement and the relation of reimbursement and federal and state guidelines and requirements to promote optimal quality of care and quality of life for the long-term care residents. Prior to working with reimbursement, I worked in Home Health in 2007 and in previous years, both as a RN and LVN. I have strong assessment skills of the geriatric population, I also have exercised and utilized critical thinking skills and able to determine to needs and care that the geriatric needs, whether via notification of MD, need for emergent care, and other determinations for optimal care in meeting health needs of the geriatric population.
JUNE 20,2022: CURRENTLY EMPLOYED AS DON AT IOWA PARK HEALTH CARE . I AM DIRECT SUPERVISOR OVER ALL THE NURSING DEPARTMENT. ENSURE ALL STATE REGULATIONS ARE BEING FOLLOWED. OVERSEE THE HIRING AND TERMINATION OF ALL NURSING STAFF. ENSURE THAT QUALITY RESIDENT CARE IS BEING GIVEN AT ALL TIMES. PROVIDE INSERVICES AND TRAININGS WITH NURSING STAFF. MONITOR WEIGHT STATUS, SKIN STATUS AND INFECTION CONTROL. PROVIDE AUDITS ON ALL PROCESSES TO ENSURE PROCESSES ARE BEING ADHERED TO FACILITY POLICIES AND STATE REGULATIONS. REVIEW AND SIGN ALL CARE PLANS AND PROVIDED SCHEDULED CARE PLAN MEETINGS WITH CARE TEAM MEMBERS, RESIDENTS AND THEIR FAMILIES AND RESPONSIBLE PARTIES. PERFORM OTHER DUTIES AS INDICATED AND NEEDED IN RELATION TO RESIDENT CARE AND STATE REQUIREMENTS. ENSURE ALL DOCUMENTATION IN RESIDENT’S RECORDS ARE ACCURATE FOR ALL CODING OF MDS AND PERSONALIZATION OF RESIDENT CARE PLANS
APRIL 25, 2022 TO JUNE 16,2022: DON AT LTC FACILITY, ELECTRA HEALTH CARE CENTER .
I WAS DIRECT SUPERVISOR OVER ALL THE NURSING DEPARTMENT. ENSURED ALL STATE REGULATIONS WERE BEING FOLLOWED. OVERSEED THE HIRING AND TERMINATION OF ALL NURSING STAFF. ENSURED THAT QUALITY RESIDENT CARE WAS BEING GIBEN AT ALL TIMES. PROVIDED INSERVICES AND TRAININGS WITH NURSING STAFF. MONITORED WEIGHT STATUS, SKIN STATUS AND INFECTION CONTROL. PROVIDED AUDITS ON ALL PROCESSES TO ENSURE PROCESSES WERE ADHERED TO FACILITY POLICIES AND STATE REGULATIONS. REVIEWED AND SIGNED ALL CARE PLANS AND PROVIDED SCHEDULED CARE PLAN MEETINGS WITH CARE TEAM MEMBERS, RESIDENTS AND THEIR FAMILIES AND RESPONSIBLE PARTIES. PERFORMED OTHER DUTIES AS INDICATED AND NEEDED IN RELATION TO RESIDENT CARE AND STATE REQUIREMENTS. LEFT THIS POSITION TO ACCEPT A DON POSITION AT IOWA PARK HEALTH CARE FOR SIGNIFICANT PAY INCREASE.
EMPLOYED THROUGH APRIL 2022: EXECUTIVE DIRECTOR AT EAGLE FLATS VILLAGE ASSISTED LIVING FACILITY
• AS THE EXECUTIVE DIRECTOR I HAVE TO MONITOR CENSUS AND PROMOTE ADMISSIONS, MONITOR ALL DEPARTMENT HEADS TO ENSURE THAT THEIR BUDGET SPIN DOWN REPORTS ARE WITHIN THEIR INDIVIDUAL BUDGETS. I MONITOR ACCOUNTS PAYABLE AND ACCOUNTS RECEIVABLE. OVER SEE ALL DEPARTMENTS IN THE FACILITY AND ENCOURAGE TEAM BUILDING AND EXCERCISING ALL EMPLOYEES IN ALL DEPARTMENTS ARE ADHEREING TO THE STATE REQUIREMENTS FOR TYPE B ASSISTED LIVING FACILITIES
•
EMPLOYED FROM 12/03/2014 TO DEC 3 2015 AS MDS/REIMBURSEMENT/ CARE PLAN COORDINATOR AT TEXHOMA CHRISTIAN CARE CENTER:
• RESPONSIBLE FOR TRAINING AND EDUCATING ALL 5 STAFF ON THE MDS TEAM IN ACCURATE CODING OF THE MDS PER RAI MANUAL ADHERING TO FEDERAL AND STATE GUIDELINES, MAINTAINING CURRENT WITH ALL MEDICARE AND MEDICAID CHANGES AS IT RELATES TO MDS AND PROVIDING TRAININGS AND IN-SERVICES WITH THE MDS STAFF.
• TRAINING, IN-SERVICING AND AUDITING THE CNAS IN DOCUMENTING ADLS IN THE KIOSK POINT OF CARE ACCURATELY PER MANDATES OF STATE AND FEDERAL GUIDELINES IN COMPLIANCE WITH THE MDS RAI FEDERAL GUIDELINES
• TRAIN AND AUDIT MDS STAFF ON CARE PLANNING, OR REQUIRED UPDATING OF THE CARE PLAN IN LONG TERM CARE AND HOW TO WRITE A VERY PERSONALIZED CARE PLAN ADDRESSING RISK FOR AND CURRENT PROBLEMS UNIQUE AND INDIVIDUALIZED TO THE RESIDENT AND SETTING TARGET DATES AND CREATING GOALS THAT ARE MEASURABLE WITH INDIVIDUALIZED APPROACHES
• AUDIT MDS FOR ACCURACY AND ADHERENCE TO FEDERAL AND STATE GUIDELINES, AUDITIING AND REVIEWING CARE PLANS ENSURING THE CARE PLAN IS INDIVIDUALIZED AND PERSONALIZED AND APPROPRIATE FOR EACH RESIDENT
• ENSURE THAT ALL MDS HAVE SUPPORTING DOCUMENTATION IN THE CLINICAL RECORD AND ADHERES TO THE RAI PROCESS IN CODING THE MDS TO ESTABLISH REIMBURSEMENT ACCURATELY AND APPROPRIATELY FOR ALL THE CARE THAT IS PROVIDED BY THE FACILITY
• ASSESS THE RESIDENTS FOR DECLINES IN ADL STATUS AND ANY RESIDENTS THAT WOULD BENEFIT FROM PT, OT OR ST, AND REQUEST SCREENING BY APPROPRIATE THERAPY DISCIPLINES
• MONITOR TIME SHEETS, ESTABLISH SCHEDULES AND COMPLETE EVALUATIONS ON THE MDS STAFF
• PROVIDE IN-SERVICES TO THE CHARGE NURSES AND LIC NURSES ON ACCURATE AND APPROPRIATE DOCUMENTATION IN THE CLINICAL RECORD
• ON CALL ROTATION FOR COMPREHENSIVE ADMISSION ASSESSMENTS ON ALL NEW ADMISSIONS, INPUT ORDERS ON NEW ADMISSIONS AND OBTAIN SIGNED CONSENTS FOR PSYCHOTROPIC MEDICATIONS, FALL ASSESSMENTS, LEAD AND GUIDE CHARGE NURSES ON CRITICAL HEALTH CONDITIONS, CHANGES IN RESIDENT STATUS, ETC AND WITH USE OF CRITICAL THINKING SKILLS, MAKE A INFORMED DECISION TO DETERMINE SPECIFIC CARE NEEDS, ER OR OUTSIDE MEDICAL TREATMENT, HOSPITAL REFERRALS AND MD NOTIFICATION. CREATE ADMISSION INTERIM CARE PLAN AND OPEN THE COMPREHENSIVE CARE PLAN, FOR THE MDS COORDINATOR TO UPDATE FOR REVIEW PRN AND AS REQUIRED BY STATE AND FEDERAL GUIDELINES.
MOBILE MDS: CURRENT POSITION WITH FUNDAMENTAL LTC. DATE OF EMPLOYMENT 2/10/2014 TO 12/03/2014:
• WILL BE POINT PERSON FOR ALL OIG REVIEWS WITH FUNDAMENTAL LTC FACILITIES IN TEXAS.
• ENSURE MDS COORDINATORS, MEDICAL RECORDS PERSONS, ETC ARE ALL AVAILABLE AND ASSIST IN GETTING DOCUMENTATION TO SUPPORT RUG, MDS, LTCMIS AT REQUEST OF OIG REVIEWERS
• ASSIST WITH PROCESS OF ENTRANCE, EXIT AND RECONSIDERATIONS PROCESS FOR ANY RUGS TAKEN AND LOWERED BY REVIEW.
• PERFORM MDS TASKS IN BLDGS WITHOUT A MDS COORDINATOR, TO INCLUDE COMPLETION OF MDS AND ALL RAI PROCESSES, ATTEND MORNING MEETINGS, SETTING OF ARDS MAXIMIZE RUGS, COMPLETION OF LTCMIS, CARE PLAN PROCESSES, TRIPLE CHECK AND PASRRS.
REGIONAL REIMBURSEMENT CONSULTANT: RECENT POSITION WITH ADVANCED HEALTH CARE. DATE OF EMPLOYMENT WAS JUNE 20, 2011 TO 1/30/2014
• REIMBURSEMENT PROCESS WITH THE MEDICARE/MEDICAID SYSTEMS IN LONG TERM CARE FACILITIES.
• PROVIDES ASSISTANCE TO FACILITIES ON MEDICARE AND MEDICAID-RELATED AREAS (ELIGIBILITY, CERTIFICATION COVERAGE, UTILIZATION AND REIMBURSEMENT. UPDATES FACILITY STAFF WITH ANY CHANGES AND FOLLOW-UP PROBLEM AREAS.
• INTERACTS WITH ADMINISTRATORS, DON’S, MEDICARE PPS/MEDICAID OBRA COORDINATORS/ADON’S TO ASSIST FACILITIES IN COMPLYING WITH COMPANY PROCEDURES AND FEDERAL, STATE AND LOCAL REGULATIONS IN RELATION TO ALL ASPECTS OF REIMBURSEMENT. INSTRUCT/TRAIN/SUPERVISE LTCMI COMPLETION/SUBMISSION FOR MEDICAID. WORK CLOSELY WITH BOM’S IN RELATION TO BILLING REGARDLESS OF PAYER SOURCE, INCLUDING HMO AND INSURANCE.
• SUBMITS DAILY FACILITY ON SITE VISIT REPORTS, WEEKLY REVIEW OF ALL FACILITIES, ASSESSING COMPLIANCE AND WORK PERFORMANCE .TRAINS FACILITY STAFF ON MDS INPUT, WEEKLY REIMBURSEMENT MEETINGS, AND MDS RELATED FUNCTIONS, TRAINS FACILITY STAFF ON CONDUCTING PPS,LOC,TRIPLE CHECKS AND CASE MGM MEETINGS
• TRAINING TO FACILITY STAFF ON LTCMI INPUT AND MEETING MEDICAL NECESSITY, MANAGING PENDING DENIALS AND DENIALS
• REVIEWS PENDING ADMISSIONS TO ENSURE THEY WILL BE ABLE TO MEET MEDICAL NECESSITY
• TRAIN FACILITY STAFF ON ABN DENIAL LETTERS AND PROCESS WHEN RESIDENTS ARE COMING OFF MEDICARE
• TRAIN FACILITY STAFF ON CARE PLANS ENSURING THE CARE PLANS ARE PERSONALIZED AND CAA’S TRIGGERS ARE CARE PLANNED ACCORDINGLY.
• REVIEW FACILITIES CMI TO ENSURE THEY ARE CAPTURING THE HIGHEST POSSIBLE RUG TO INCREASE CMI AND PPS REIMBURSEMENT
• TRAIN ON TRACKING PROCESS OF MEDICARE & MEDICAID RESIDENTS
• HOLD CONFERENCE CALLS, HOLD TRAINING SESSIONS, CREATE POWER POINTS UTILIZED IN ALL TRAININGS.
• WORKS WITH AND ANSWERS DIRECTLY TO THE V/P OF REIMBURSEMENT
• PERFORMS PRE SURVEY TASK IN RELATION TO MDS PROCESS AND OTHER CLINICAL AREAS. KEY FACTOR REVIEWS RELATED TO MDS ACCURACY AND COMPLIANCE WITH COMPANIES POLICIES AND PROTOCOLS, AND TIMELY COMPLETION AND SUBMISSION OF THE MDS AND LTCMI
IN JANUARY, 2010, I WENT TO WORK FOR FUNDAMENTAL AS A CASE MIX DIRECTOR, WORKING IN THE SAME ROLE AS REIMBURSEMENT CONSULTANT WITH ADVANCED HEALTHCARE SOLUTIONS. ALSO DID PRESENTATIONS TO NEW NAC ORIENTATION, IN WHICH I WROTE AND PRESENTED POWER POINTS ON 9 MDS SECTIONS FOR MDS 3.0. I MANAGED 9 TO 13 FACILITIES DURING MY EMPLOYMENT WITH FUNDAMENTAL.
JUNE 20, 2011 IS WHEN I RETURNED TO WORK AT ADVANCED HEALTHCARE SOLUTIONS AS THE REGIONAL REIMBURSEMENT CONSULTANT.
NOTE: FROM 1996 TO 1997 AND THEN AGAIN FROM 1998 TO 1999 I WAS THE MDS/MEDICARE MANAGER, AS WELL AS, COMPLETED MDS’S AND CARE PLANS. IN 1999, AS DON IN SEVERAL SMALLER FACILITIES FROM 1999 TO 2006. FROM 1997 TO 1998, I OPENED THE VERNON BRANCH FOR TORCH HOME HEALTH AND WAS THE ADMINISTRATOR/DIRECTOR OF NURSES UNTIL TORCH CLOSED THEIR DOORS DUE TO MEDICARE CHANGES IN HOME HEALTH. I HAVE WORKED AS A DON, AT SEVERAL FACILITIES AND UNDER DIFFERENT CORPORATIONS SINCE 1998 THRU 2006. FROM 2006 TO 2007 I WORKED AS THE RN CHARGE NURSE AT PRESBYTERIAN HOSPITAL IN DENTON. JUNE 2008 I WORKED AS A RN CASE MANAGER IN HOME HEALTH. DURING THE TIME I WAS WORKING IN HOME HEALTH I WORKED PART TIME IN COMPLETING THE MDS AND CARE PLANS IN A LONG TERM CARE SETTING AT EVERGREEN HEALTHCARE FROM MARCH THRU MAY 31, 2008.
ON JUNE 30, 2008 I WORKED AS A TRAVELING REIMBURSEMENT SPECIALIST FOR P&M HEALTHCARE (WHICH SOLD TO ADVANCED HEALTHCARE SOLUTIONS ON 11/30/09) I WOULD GO INTO LTC FACILITIES AND WORK ON MDS, LTCMI’S AND CARE PLANS WHEN THEIR WAS AN OPEN POSITION, OR THE MDS ADON/COORDINATOR WAS ILL OR ON VACATION AT VARIOUS FACILITIES FOR P&M HEALTHCARE. I WAS PROMOTED TO REGIONAL REIMBURSEMENT CONSULTANT ON APRIL 14TH 2009. I HAVE WORKED AS AN RN CASE MANAGER FOR HOME HEALTH, AND PRIOR TO COMPLETING MY ASSOC DEGREE AS AN RN, AS AN LVN I WORKED IN HOME HEALTH AS AN LVN NURSE MAKING ON SITE VISITS. I WORKED AS AN LVN FROM 1974, AND RECEIVED MY RN ASSOC DEGREE IN 1994. I HAVE WORKED IN VARIOUS FIELDS OF NURSING BUT PRIMARILY IN GERIATRICS. I HAVE WORKED AT STATE HOSPITALS FOR MENTAL ILLNESS, WORKED AT STATE SCHOOLS FOR CLIENTS THAT WERE DIAGNOSED WITH SEVERE MENTAL RETARDATIONS WITH IDD AND DDD TO INCLUDE CEREBRAL PALSY, EPILEPSY AND OTHER DDD. I DID IN HOUSE IV THERAPY IN LTC FACILITIES COVERING A 50 MILE RADIUS. I HAVE PROVIDED WOUND VAC CARE, LAB DRAWS, ETC. AND HAVE A VARIED SCOPE OF NURSE EXPERIENCE.
EDUCATION
• VERNON REGIONAL JUNIOR COLLEGE
VERNON, TEXAS
GRADUATED: 05/94
ASSOCIATE DEGREE IN NURSING
• BETHANIA SCHOOL OF VOCATIONAL NURSING
WICHITA FALLS, TEXAS
GRADUATED: 08/74
LVN LICENSURE
LICENSE
• REGISTERED NURSING LICENSE #604535 EXPIRES: 08/31/2018
REFERENCES:
HOME HEALTH EMPLOYMENT:
TANYA INGLISH, DON AT SPECIALTY NURSES OF VERNON
SUE ANN WATTS CURRENT DON AT SPECIALITY NURSES OF VERNON
DON EMPLOYMENT:
MARCIA JACOBI, ADMIN AT RIVER OAKS NURSING AND REHAB AND AT IOWA PARK NRSG & REHAB:
SHERRY MCCOY, ADMIN AT IOWA PARK NURSING CENTER
REGIONAL REIMBURSEMENT CONSULTANT:
LORI NABORS, VP OF REIMBURSEMENT FOR ADVANCED HEALTHCARE SOLUTIONS AND CURRRENTLY RVP OF REIMURSEMENT FOR PARAGON HEALTH CARE
RANDY CARPENTER VP OF REIMBURSEMENT FOR FUNDAMENTAL
PERSONAL REFERENCE:
HOLLY JANCA, REIMBURSEMENT CONSULTANT 361-***-****
CYNTHIA HENSARLING, REIMBURSEMENT CONSULTANT 409-***-****
KATHY KERR, MDS COORDINATOR: 940-***-****
RENATA WILTSE, MDS COORDINATOR : 940-***-****
JUDY G. EMBERS
11228 FM 2073
VERNON, TEXAS 76384
OBJECTIVE
SEEKING A FULL TIME POSITION AS A SKILLED, CONFIDENT, EDUCATED REGISTERED NURSE. LOOKING FOR A HEALTHCARE ORGANIZATION THAT WILL UTILIZE ARS OF EXPERIENCE. I AM INTERESTED IN POSITION THAT WILL UTILIZE MY EXPERIENCE IN THE CARE OF THE GERIATRIC PATIENTS, RESIDENTS OR CLIENTS WITH A POSITION THAT WILL FURTHER ENHANCE EXPERIENCE AND SKILLS WHETHER IN DIRECT PATIENT CARE, BILLING, OR MANAGEMENT POSITION.
QUALIFICATIONS/SKILLS
STRONG ORGANIZATIONAL SKILLS EFFECTIVE COMMUNICATOR WITH PROVEN RESULTS
EXCELLENT CLINICAL SKILLS STRONG LEADERSHIP, MENTOR QUALITIES
SOLID MEDICAL KNOWLEDGE PATIENT ADVOCATE
COMPUTER KNOWLEDGE DON/ADMINISTRATOR EXPERIENCED
HOME HEALTH EXPERIENCE MENTAL HEALTH, MEDICAL-SURGICAL EXPERIENCE
REIMBURSEMENT WITH MEDICARE AND MEDICAID SYSTEM (LTCMI)
Professional Experience: I have been in reimbursement for Long term care since 2008 as a Regional reimbursement consultant for long term care facilities and I been employed in a facility as the MDS/Reimbursement/ care plan coordinator. I am knowledgeable in all aspects of the MDS, RUG analysis, Case Mix Index, payment for Medicare and Texas Medicaid. I am knowledgeable in federal guidelines and Regulations of the RAI Process, Dad’s regulations for Texas, Medicaid guidelines and regulations based on the Texas Administrative Code (TAC), CMS as it relates to Texas Compliance and Regulations for reimbursement and the relation of reimbursement and federal and state guidelines and requirements to promote optimal quality of care and quality of life for the long-term care residents. Prior to working with reimbursement, I worked in Home Health in 2007 and in previous years, both as a RN and LVN. I have strong assessment skills of the geriatric population, I also have exercised and utilized critical thinking skills and able to determine to needs and care that the geriatric needs, whether via notification of MD, need for emergent care, and other determinations for optimal care in meeting health needs of the geriatric population.
JUNE 20,2022: CURRENTLY EMPLOYED AS DON AT IOWA PARK HEALTH CARE . I AM DIRECT SUPERVISOR OVER ALL THE NURSING DEPARTMENT. ENSURE ALL STATE REGULATIONS ARE BEING FOLLOWED. OVERSEE THE HIRING AND TERMINATION OF ALL NURSING STAFF. ENSURE THAT QUALITY RESIDENT CARE IS BEING GIVEN AT ALL TIMES. PROVIDE INSERVICES AND TRAININGS WITH NURSING STAFF. MONITOR WEIGHT STATUS, SKIN STATUS AND INFECTION CONTROL. PROVIDE AUDITS ON ALL PROCESSES TO ENSURE PROCESSES ARE BEING ADHERED TO FACILITY POLICIES AND STATE REGULATIONS. REVIEW AND SIGN ALL CARE PLANS AND PROVIDED SCHEDULED CARE PLAN MEETINGS WITH CARE TEAM MEMBERS, RESIDENTS AND THEIR FAMILIES AND RESPONSIBLE PARTIES. PERFORM OTHER DUTIES AS INDICATED AND NEEDED IN RELATION TO RESIDENT CARE AND STATE REQUIREMENTS. ENSURE ALL DOCUMENTATION IN RESIDENT’S RECORDS ARE ACCURATE FOR ALL CODING OF MDS AND PERSONALIZATION OF RESIDENT CARE PLANS
APRIL 25, 2022 TO JUNE 16,2022: DON AT LTC FACILITY, ELECTRA HEALTH CARE CENTER .
I WAS DIRECT SUPERVISOR OVER ALL THE NURSING DEPARTMENT. ENSURED ALL STATE REGULATIONS WERE BEING FOLLOWED. OVERSEED THE HIRING AND TERMINATION OF ALL NURSING STAFF. ENSURED THAT QUALITY RESIDENT CARE WAS BEING GIBEN AT ALL TIMES. PROVIDED INSERVICES AND TRAININGS WITH NURSING STAFF. MONITORED WEIGHT STATUS, SKIN STATUS AND INFECTION CONTROL. PROVIDED AUDITS ON ALL PROCESSES TO ENSURE PROCESSES WERE ADHERED TO FACILITY POLICIES AND STATE REGULATIONS. REVIEWED AND SIGNED ALL CARE PLANS AND PROVIDED SCHEDULED CARE PLAN MEETINGS WITH CARE TEAM MEMBERS, RESIDENTS AND THEIR FAMILIES AND RESPONSIBLE PARTIES. PERFORMED OTHER DUTIES AS INDICATED AND NEEDED IN RELATION TO RESIDENT CARE AND STATE REQUIREMENTS. LEFT THIS POSITION TO ACCEPT A DON POSITION AT IOWA PARK HEALTH CARE FOR SIGNIFICANT PAY INCREASE.
EMPLOYED THROUGH APRIL 2022: EXECUTIVE DIRECTOR AT EAGLE FLATS VILLAGE ASSISTED LIVING FACILITY
• AS THE EXECUTIVE DIRECTOR I HAVE TO MONITOR CENSUS AND PROMOTE ADMISSIONS, MONITOR ALL DEPARTMENT HEADS TO ENSURE THAT THEIR BUDGET SPIN DOWN REPORTS ARE WITHIN THEIR INDIVIDUAL BUDGETS. I MONITOR ACCOUNTS PAYABLE AND ACCOUNTS RECEIVABLE. OVER SEE ALL DEPARTMENTS IN THE FACILITY AND ENCOURAGE TEAM BUILDING AND EXCERCISING ALL EMPLOYEES IN ALL DEPARTMENTS ARE ADHEREING TO THE STATE REQUIREMENTS FOR TYPE B ASSISTED LIVING FACILITIES
•
EMPLOYED FROM 12/03/2014 TO DEC 3 2015 AS MDS/REIMBURSEMENT/ CARE PLAN COORDINATOR AT TEXHOMA CHRISTIAN CARE CENTER:
• RESPONSIBLE FOR TRAINING AND EDUCATING ALL 5 STAFF ON THE MDS TEAM IN ACCURATE CODING OF THE MDS PER RAI MANUAL ADHERING TO FEDERAL AND STATE GUIDELINES, MAINTAINING CURRENT WITH ALL MEDICARE AND MEDICAID CHANGES AS IT RELATES TO MDS AND PROVIDING TRAININGS AND IN-SERVICES WITH THE MDS STAFF.
• TRAINING, IN-SERVICING AND AUDITING THE CNAS IN DOCUMENTING ADLS IN THE KIOSK POINT OF CARE ACCURATELY PER MANDATES OF STATE AND FEDERAL GUIDELINES IN COMPLIANCE WITH THE MDS RAI FEDERAL GUIDELINES
• TRAIN AND AUDIT MDS STAFF ON CARE PLANNING, OR REQUIRED UPDATING OF THE CARE PLAN IN LONG TERM CARE AND HOW TO WRITE A VERY PERSONALIZED CARE PLAN ADDRESSING RISK FOR AND CURRENT PROBLEMS UNIQUE AND INDIVIDUALIZED TO THE RESIDENT AND SETTING TARGET DATES AND CREATING GOALS THAT ARE MEASURABLE WITH INDIVIDUALIZED APPROACHES
• AUDIT MDS FOR ACCURACY AND ADHERENCE TO FEDERAL AND STATE GUIDELINES, AUDITIING AND REVIEWING CARE PLANS ENSURING THE CARE PLAN IS INDIVIDUALIZED AND PERSONALIZED AND APPROPRIATE FOR EACH RESIDENT
• ENSURE THAT ALL MDS HAVE SUPPORTING DOCUMENTATION IN THE CLINICAL RECORD AND ADHERES TO THE RAI PROCESS IN CODING THE MDS TO ESTABLISH REIMBURSEMENT ACCURATELY AND APPROPRIATELY FOR ALL THE CARE THAT IS PROVIDED BY THE FACILITY
• ASSESS THE RESIDENTS FOR DECLINES IN ADL STATUS AND ANY RESIDENTS THAT WOULD BENEFIT FROM PT, OT OR ST, AND REQUEST SCREENING BY APPROPRIATE THERAPY DISCIPLINES
• MONITOR TIME SHEETS, ESTABLISH SCHEDULES AND COMPLETE EVALUATIONS ON THE MDS STAFF
• PROVIDE IN-SERVICES TO THE CHARGE NURSES AND LIC NURSES ON ACCURATE AND APPROPRIATE DOCUMENTATION IN THE CLINICAL RECORD
• ON CALL ROTATION FOR COMPREHENSIVE ADMISSION ASSESSMENTS ON ALL NEW ADMISSIONS, INPUT ORDERS ON NEW ADMISSIONS AND OBTAIN SIGNED CONSENTS FOR PSYCHOTROPIC MEDICATIONS, FALL ASSESSMENTS, LEAD AND GUIDE CHARGE NURSES ON CRITICAL HEALTH CONDITIONS, CHANGES IN RESIDENT STATUS, ETC AND WITH USE OF CRITICAL THINKING SKILLS, MAKE A INFORMED DECISION TO DETERMINE SPECIFIC CARE NEEDS, ER OR OUTSIDE MEDICAL TREATMENT, HOSPITAL REFERRALS AND MD NOTIFICATION. CREATE ADMISSION INTERIM CARE PLAN AND OPEN THE COMPREHENSIVE CARE PLAN, FOR THE MDS COORDINATOR TO UPDATE FOR REVIEW PRN AND AS REQUIRED BY STATE AND FEDERAL GUIDELINES.
MOBILE MDS: CURRENT POSITION WITH FUNDAMENTAL LTC. DATE OF EMPLOYMENT 2/10/2014 TO 12/03/2014:
• WILL BE POINT PERSON FOR ALL OIG REVIEWS WITH FUNDAMENTAL LTC FACILITIES IN TEXAS.
• ENSURE MDS COORDINATORS, MEDICAL RECORDS PERSONS, ETC ARE ALL AVAILABLE AND ASSIST IN GETTING DOCUMENTATION TO SUPPORT RUG, MDS, LTCMIS AT REQUEST OF OIG REVIEWERS
• ASSIST WITH PROCESS OF ENTRANCE, EXIT AND RECONSIDERATIONS PROCESS FOR ANY RUGS TAKEN AND LOWERED BY REVIEW.
• PERFORM MDS TASKS IN BLDGS WITHOUT A MDS COORDINATOR, TO INCLUDE COMPLETION OF MDS AND ALL RAI PROCESSES, ATTEND MORNING MEETINGS, SETTING OF ARDS MAXIMIZE RUGS, COMPLETION OF LTCMIS, CARE PLAN PROCESSES, TRIPLE CHECK AND PASRRS.
REGIONAL REIMBURSEMENT CONSULTANT: RECENT POSITION WITH ADVANCED HEALTH CARE. DATE OF EMPLOYMENT WAS JUNE 20, 2011 TO 1/30/2014
• REIMBURSEMENT PROCESS WITH THE MEDICARE/MEDICAID SYSTEMS IN LONG TERM CARE FACILITIES.
• PROVIDES ASSISTANCE TO FACILITIES ON MEDICARE AND MEDICAID-RELATED AREAS (ELIGIBILITY, CERTIFICATION COVERAGE, UTILIZATION AND REIMBURSEMENT. UPDATES FACILITY STAFF WITH ANY CHANGES AND FOLLOW-UP PROBLEM AREAS.
• INTERACTS WITH ADMINISTRATORS, DON’S, MEDICARE PPS/MEDICAID OBRA COORDINATORS/ADON’S TO ASSIST FACILITIES IN COMPLYING WITH COMPANY PROCEDURES AND FEDERAL, STATE AND LOCAL REGULATIONS IN RELATION TO ALL ASPECTS OF REIMBURSEMENT. INSTRUCT/TRAIN/SUPERVISE LTCMI COMPLETION/SUBMISSION FOR MEDICAID. WORK CLOSELY WITH BOM’S IN RELATION TO BILLING REGARDLESS OF PAYER SOURCE, INCLUDING HMO AND INSURANCE.
• SUBMITS DAILY FACILITY ON SITE VISIT REPORTS, WEEKLY REVIEW OF ALL FACILITIES, ASSESSING COMPLIANCE AND WORK PERFORMANCE .TRAINS FACILITY STAFF ON MDS INPUT, WEEKLY REIMBURSEMENT MEETINGS, AND MDS RELATED FUNCTIONS, TRAINS FACILITY STAFF ON CONDUCTING PPS,LOC,TRIPLE CHECKS AND CASE MGM MEETINGS
• TRAINING TO FACILITY STAFF ON LTCMI INPUT AND MEETING MEDICAL NECESSITY, MANAGING PENDING DENIALS AND DENIALS
• REVIEWS PENDING ADMISSIONS TO ENSURE THEY WILL BE ABLE TO MEET MEDICAL NECESSITY
• TRAIN FACILITY STAFF ON ABN DENIAL LETTERS AND PROCESS WHEN RESIDENTS ARE COMING OFF MEDICARE
• TRAIN FACILITY STAFF ON CARE PLANS ENSURING THE CARE PLANS ARE PERSONALIZED AND CAA’S TRIGGERS ARE CARE PLANNED ACCORDINGLY.
• REVIEW FACILITIES CMI TO ENSURE THEY ARE CAPTURING THE HIGHEST POSSIBLE RUG TO INCREASE CMI AND PPS REIMBURSEMENT
• TRAIN ON TRACKING PROCESS OF MEDICARE & MEDICAID RESIDENTS
• HOLD CONFERENCE CALLS, HOLD TRAINING SESSIONS, CREATE POWER POINTS UTILIZED IN ALL TRAININGS.
• WORKS WITH AND ANSWERS DIRECTLY TO THE V/P OF REIMBURSEMENT
• PERFORMS PRE SURVEY TASK IN RELATION TO MDS PROCESS AND OTHER CLINICAL AREAS. KEY FACTOR REVIEWS RELATED TO MDS ACCURACY AND COMPLIANCE WITH COMPANIES POLICIES AND PROTOCOLS, AND TIMELY COMPLETION AND SUBMISSION OF THE MDS AND LTCMI
IN JANUARY, 2010, I WENT TO WORK FOR FUNDAMENTAL AS A CASE MIX DIRECTOR, WORKING IN THE SAME ROLE AS REIMBURSEMENT CONSULTANT WITH ADVANCED HEALTHCARE SOLUTIONS. ALSO DID PRESENTATIONS TO NEW NAC ORIENTATION, IN WHICH I WROTE AND PRESENTED POWER POINTS ON 9 MDS SECTIONS FOR MDS 3.0. I MANAGED 9 TO 13 FACILITIES DURING MY EMPLOYMENT WITH FUNDAMENTAL.
JUNE 20, 2011 IS WHEN I RETURNED TO WORK AT ADVANCED HEALTHCARE SOLUTIONS AS THE REGIONAL REIMBURSEMENT CONSULTANT.
NOTE: FROM 1996 TO 1997 AND THEN AGAIN FROM 1998 TO 1999 I WAS THE MDS/MEDICARE MANAGER, AS WELL AS, COMPLETED MDS’S AND CARE PLANS. IN 1999, AS DON IN SEVERAL SMALLER FACILITIES FROM 1999 TO 2006. FROM 1997 TO 1998, I OPENED THE VERNON BRANCH FOR TORCH HOME HEALTH AND WAS THE ADMINISTRATOR/DIRECTOR OF NURSES UNTIL TORCH CLOSED THEIR DOORS DUE TO MEDICARE CHANGES IN HOME HEALTH. I HAVE WORKED AS A DON, AT SEVERAL FACILITIES AND UNDER DIFFERENT CORPORATIONS SINCE 1998 THRU 2006. FROM 2006 TO 2007 I WORKED AS THE RN CHARGE NURSE AT PRESBYTERIAN HOSPITAL IN DENTON. JUNE 2008 I WORKED AS A RN CASE MANAGER IN HOME HEALTH. DURING THE TIME I WAS WORKING IN HOME HEALTH I WORKED PART TIME IN COMPLETING THE MDS AND CARE PLANS IN A LONG TERM CARE SETTING AT EVERGREEN HEALTHCARE FROM MARCH THRU MAY 31, 2008.
ON JUNE 30, 2008 I WORKED AS A TRAVELING REIMBURSEMENT SPECIALIST FOR P&M HEALTHCARE (WHICH SOLD TO ADVANCED HEALTHCARE SOLUTIONS ON 11/30/09) I WOULD GO INTO LTC FACILITIES AND WORK ON MDS, LTCMI’S AND CARE PLANS WHEN THEIR WAS AN OPEN POSITION, OR THE MDS ADON/COORDINATOR WAS ILL OR ON VACATION AT VARIOUS FACILITIES FOR P&M HEALTHCARE. I WAS PROMOTED TO REGIONAL REIMBURSEMENT CONSULTANT ON APRIL 14TH 2009. I HAVE WORKED AS AN RN CASE MANAGER FOR HOME HEALTH, AND PRIOR TO COMPLETING MY ASSOC DEGREE AS AN RN, AS AN LVN I WORKED IN HOME HEALTH AS AN LVN NURSE MAKING ON SITE VISITS. I WORKED AS AN LVN FROM 1974, AND RECEIVED MY RN ASSOC DEGREE IN 1994. I HAVE WORKED IN VARIOUS FIELDS OF NURSING BUT PRIMARILY IN GERIATRICS. I HAVE WORKED AT STATE HOSPITALS FOR MENTAL ILLNESS, WORKED AT STATE SCHOOLS FOR CLIENTS THAT WERE DIAGNOSED WITH SEVERE MENTAL RETARDATIONS WITH IDD AND DDD TO INCLUDE CEREBRAL PALSY, EPILEPSY AND OTHER DDD. I DID IN HOUSE IV THERAPY IN LTC FACILITIES COVERING A 50 MILE RADIUS. I HAVE PROVIDED WOUND VAC CARE, LAB DRAWS, ETC. AND HAVE A VARIED SCOPE OF NURSE EXPERIENCE.
EDUCATION
• VERNON REGIONAL JUNIOR COLLEGE
VERNON, TEXAS
GRADUATED: 05/94
ASSOCIATE DEGREE IN NURSING
• BETHANIA SCHOOL OF VOCATIONAL NURSING
WICHITA FALLS, TEXAS
GRADUATED: 08/74
LVN LICENSURE
LICENSE
• REGISTERED NURSING LICENSE #604535 EXPIRES: 08/31/2018
REFERENCES:
HOME HEALTH EMPLOYMENT:
TANYA INGLISH, DON AT SPECIALTY NURSES OF VERNON
SUE ANN WATTS CURRENT DON AT SPECIALITY NURSES OF VERNON
DON EMPLOYMENT:
MARCIA JACOBI, ADMIN AT RIVER OAKS NURSING AND REHAB AND AT IOWA PARK NRSG & REHAB:
SHERRY MCCOY, ADMIN AT IOWA PARK NURSING CENTER
REGIONAL REIMBURSEMENT CONSULTANT:
LORI NABORS, VP OF REIMBURSEMENT FOR ADVANCED HEALTHCARE SOLUTIONS AND CURRRENTLY RVP OF REIMURSEMENT FOR PARAGON HEALTH CARE
RANDY CARPENTER VP OF REIMBURSEMENT FOR FUNDAMENTAL
PERSONAL REFERENCE:
HOLLY JANCA, REIMBURSEMENT CONSULTANT 361-***-****
CYNTHIA HENSARLING, REIMBURSEMENT CONSULTANT 409-***-****
KATHY KERR, MDS COORDINATOR: 940-***-****
RENATA WILTSE, MDS COORDINATOR : 940-***-****
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