MDS Coordinator

Intersect Healthcare, Inc.; Hancock Township (MI); On-site; USD 80,000 - 100,000; Full time

Job summary

Intersect Healthcare, Inc. is seeking a Licensed Registered Nurse (MI) to coordinate the Resident Assessment Instrument (RAI) process across the facility, ensuring accurate assessments and compliant billing per OBRA, Medicare, and Medicaid policies.

The role oversees MDS/RAI activities, mentors the Interdisciplinary Team, supports PPS and Medicare reimbursement, and collaborates with Accounts Receivable. Knowledge of CMS guidelines and Point Click Care is preferred; travel may be required.

Qualifications

• Must be a licensed RN in Michigan.
• Minimum 5 years clinical experience with long-term care preferred.
• AANAC certification preferred.

Responsibilities

• Coordinate RAI/MDS/CAAS and PPS processes for timely completion and compliant reimbursement.
• Lead PPS/Medicare meetings for efficiencies and accuracy.
• Coach IDT in RAI process and PPS requirements to improve coding and survey readiness.
• Coordinate communication with Accounts Receivable regarding RAI-related billing.
• Provide monthly QAPI reports and track 5 Star and reimbursement outcomes.

Skills

IDT coordination

Mentoring

Communication skills

ICD coding knowledge

Education

Licensed Registered Nurse (Michigan)

5 years clinical experience (LT care preferred)

AANAC certification preferred

Job description

Position Summary:

Coordination of the Resident Assessment Instrument (RAI) process in the facility to promote accurate completion of assessments and optimal reimbursement of services in accordance with Medicare, Medicaid, OBRA, and any other payer program requirements for all residents in the facility in accordance with all federal and state certification guidelines.

Sign on Bonus $10,000.00

Principal Duties and Responsibilities:

• Maintains and communicates compliance of the OBRA & PPS regulatory date requirements and timely transmits all the required MDS' and RAI/PPS per state and federal regulation.
• Leads and monitors the activity of all facility RAI processes for timely completion of all elements (i.e. MDS, CAAS, Care Planning, Transmissions, and error follow-up).
• Coordinates PPS/MDS processes for maximization of Medicare reimbursement and maintains compliance with related regulations.
• Sets reference dates according to the CMS' MDS Manual and maintain schedules for timely completion of assessments.
• Coaches, mentors, and teaches Interdisciplinary Team (IDT) in RAI process and Prospective Payment System process to promote proficiency and increase efficiency and accuracy in designated roles.
• Participates in communication with the Accounts Receivable departments regarding completion of RAI processes as it relates to billing.
• Leads PPS/Medicare meetings for efficiencies and completeness.
• Exhibits proficiency with ICD Coding regulations and guidelines and acts as a super-user of Point Click Care software.
• Provides reports to the facility monthly QAPI including QMs, 5 Star, and Reimbursement outcomes with tracking, trending and analysis.
• Communicate with IDT on ways to impact better 5 Star scores through improving coding practices with MDS, Care Planning, and Survey readiness. Assist and validate the 5 Star scoring through the coding of the MDS.
• Assists facility IDT in determining and addressing MDS accuracy issues related to the Quality Measures.
• Coordinates Resident centered care for all Residents regardless of payer status
• Conducts Utilization Review with IDT on a weekly basis.
• Evaluates admission through discharge processes to validate skilled levels of care and services according to all payer source criteria.
• Completes Level of Care Determination application per Medicaid guidelines and ensures accuracy within the SSO system.
• Possesses understanding of the current RUG distribution and coaches direct care givers to improve/maintain quality documentation as it relates to RUG requirements. Validate final RUG levels for billing.
• Demonstrates understanding of OBRA RUGs as it impacts other government reports.
• Observes for resident safety and initiates reporting and documentation procedures as needed related to falls, abuse, or neglect.
• Adhere to Standard Precautions and infection control procedures.
• Assist in the dining room during assigned meals.
• Perform guardian angel assignments weekly and turn into the administrator.
• Perform other tasks as required.

Education, Training, and Experience:

• Licensed Registered Nurse in the State of Michigan required.
• Five years of clinical experience encompassing two years of experience in long term care preferred.
• Experience in management and knowledge of the Resident Assessment Instrument (RAI) process is preferred.
• Prefer AANAC certification
• Specific skills, knowledge, and abilities:
• Effectively communicates with the IDT by mentoring and evaluating the activities and performance of the RAI Process.

Other Special Requirements:

• Manual dexterity required to operate modern office equipment.
• Ability to travel as needed or assigned.

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