The MDS Coordinator is responsible for managing and directing the Process of MDS completion and plan of care. Responsibilities include managing the overall process and tracking of all Medicare/Medicaid case-mix documents in order to assure achievement of maximum allowable RUG categories. The MDS Coordinator will integrate information from nursing, dietary, social service, activity, rehabilitation, and physician services to ensure appropriate reimbursement.
Tracks Medicare / Managed residents to determine continued and appropriate Medicare/skilled eligibility and benefits period by determining skilled level of need.
Obtains pre-authorizations and ongoing certifications for managed care residents.
Performs concurrent MDS review to ensure appropriate RUGs category is achieved through the capture of appropriate clinical information. Identifies opportunities to enhance reimbursement.
Chairs weekly Medicare Meeting to promote appropriate nursing documentation and identify nursing needs. Works closely with nursing department leadership communicating noted needs. Collaborate with therapy and billing office to ensure correct diagnosis codes, ARD dates and RUG levels. Discuss upcoming assessments and ARD dates and RUG levels.
Directs the interdisciplinary team process to communicate opportunities to ensure capturing of all appropriate resources.
Ensures diagnosis coding is correct and collaborates with billing and therapy coding.
Maintains physician certifications in accordance with OBRA requirements.
Maintains an accurate schedule of all MDS assessments to include the proper reference dates throughout the resident's stay and ensures the accurate and timely submission of the MDS assessments including case-mix, OBRA and OMRA required assessments.
Maintains an accurate schedule for Care Plans to ensure timely facilitation of the care planning process.
Completes admission and discharge assessments.
Manage data entry function to the accuracy of the MDS and verify electronic transmissions to CMS.
Coordinate with Business Office throughout the month, to communicate case-mix data required for billing such as RUGs categories, modifiers, state case-mix scores, etc.
Complete Triple Check Process Monthly to ensure accuracy of assessments reference dates, therapy minutes/units, diagnosis codes and RUG levels prior to billing.
Serves as the Center resource for MDS/RUGs and state case-mix systems.
Provides case-mix education to the interdisciplinary team as appropriate.
Provides education to nursing staff regarding ADL coding and follows up to ensure proper coding is being completed.
Assist in the preparation of requests from appropriate state and/or federal regulatory agencies or agents regarding payment of services (audits, denials, appeals, etc.).
Maintains all reports and transmission data in a systematic format and stores in a safe, locked area.
Maintains a current and comprehensive knowledge of MDS and Medicare/Medicaid reimbursement.
Implements all required forms, procedures and processes relative to job responsibilities.
Performs other duties as assigned.
Graduate of an accredited School of Nursing with current RN licensure.
Minimum of one (1) year experience in long term care clinical nursing experience required.
Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization, and/or case management is highly desired.
Experience with basic computer technology.
Maintains the confidentiality of resident's information
Honor resident's personal and property rights
Understands all rights afforded to residents and acts accordingly
Stonerise Healthcare LLC