MDS Coordinator

Clinical Reimbursement Specialist

Major Purpose: To promote the capture of appropriate clinical reimbursement for services provided while ensuring the highest level of revenue integrity under the guidance of corporate established reimbursement initiatives.

Title of Supervisor: Administrator

Title of Immediate Subordinates: RAI techs as applicable.

Qualifications:

• Registered nurse with 3+ years reimbursement or similar experience in the LTC industry (preferred).
• Computer literacy (Word, Excel, Power Point, Outlook). Experience with current EMR software a plus.
• Evidence of effective written, verbal and technological communication.
• Demonstrates excellent organization, communication and presentation skills.
• Deadline driven, detail-oriented individual with strong analytical capabilities.
• Working knowledge of state and federal regulations governing the MDS and billing processes in the LTC setting.
• Ability to communicate with and elicit support from IDT members at the facility, regional, and corporate level.
• Ability to apply knowledge in state specific Medicaid and Medicare RUG methodologies.
• Ability to successfully train new MDS coordinators and IDT members with varying levels of experience as appropriate.
• Ability to conduct themselves with a fair, honest, consistent, and professional temperament.

Working Conditions: Works in appropriately lighted and ventilated environment.

Physical Requirements:

• Ability to cope with the mental, emotional, and physical stress of this deadline driven position.
• Can see and hear or use prosthetics that will enable these senses to function adequately to ensure that the requirements of this position can be fully met.
• Must function independently, have flexibility, personal integrity, and the ability to work effectively with residents, personnel, support agencies, and outside agencies.
• Must be in good health and display emotional stability.
• Must have finger, hand, leg, and arm dexterity (one leg/foot prosthesis acceptable).

Primary Functions:

• Serves/Aspires to serve, as the subject matter expert in regard to MDS completion and its impact on quality of care and revenue.
• Coordinates and provides strategic Assessment Reference Date (ARD) and completion dates as outlined in Chapter 2 of the Resident Assessment Instrument (RAI) and in accordance with state and federal payment methodologies.
• Optimizes reimbursement and identifies opportunity through tracking, trending, and analyzing relevant data within the medical record and through staff, resident, and practitioner interviews as necessary.
• Ensures compliance for all aspects of revenue integrity including but not limited to Physician Certification/Recertification and Denial letters regardless of responsibility to directly issue/manage these tasks.
• Chairs revenue related daily/weekly/monthly revenue related meetings such as Daily Revenue, Weekly Medicare/CMI, and Triple Check meetings.
• Responds promptly to facility and regional team inquiry and communication related to MDS, reimbursement and billing processes.
• Promotes, encourages, and facilitates accurate IDT documentation that is representative of the care each patient receives.
• Effectively communicates documentation pitfalls to department heads, facility leadership as appropriate.
• Collects data to ensure/contribute to the accurate completion and transmission of all required MDS assessments per regulatory guidelines.
• Provides facility level presentation/education relevant to primary job functions during monthly/quarterly meetings as appropriate.
• Assists IDT with interpretation, education and process development as relates to Quality Measure management as appropriate.
• Coordinates care plan schedules.
• Develops comprehensive care plans per federal regulation based on data collection, MDS and CAA completion and resident/staff interviews as necessary/appropriate.
• Ensures IDT updates/revisions of the comprehensive Care plan with each MDS completion.
• Participates in the interview process for new MDS coordinators as requested/appropriate.
• Assists with orientation and education of MDS coordinators and IDT members as relates to MDS completion and/or reimbursement processes as necessary.
• Provides ongoing education and communication to Administrator, clinical and other ancillary staff as relates to current state and federal regulation governing billing and reimbursement or impending changes.
• Other related duties as assigned.

Full vaccination against COVID-19 or a medical/religious exemption is required.

Salary/Wage Range

Compensation for the role will depend on a number of factors, including a candidate's qualifications, skills, competencies and experience and may fall outside of the range shown.

Benefits:

• Dental Insurance
• Health Insurance
• Vision Insurance
• Disability Insurance
• Basic Term Life and AD&D Insurance & Voluntary Term Life and AD&D Insurance
• Wellness Program
• Paid Time Off
• 401(k)
• Accident coverage, Hospital Indemnity coverage, Critical Illness coverage
• Educational Assistance for full-time or part-time employees pursuing educational opportunities that will increase the employee's qualifications and skills in the nursing field, such as an LPN or RN.

Schedule:

• 8 hour

Education:

• Associate's
• Bachelor's (Preferred)

Experience:

• Skilled Nursing Home LTC: 2 years (Preferred)
• MDS: 2 years (Preferred)

License/Certification:

• State licensure as a Registered Nurse (RN) or Licensed Practical Nurse (LPN)

Work Location: One location

We are committed to maintaining a diverse and inclusive workplace. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for our job opportunities.