MDS Coordinator

IntersectHC; Michigan; Hybrid; USD 90,000 - 110,000; Full time

Job summary

IntersectHC in Michigan is seeking a licensed Registered Nurse to coordinate the Resident Assessment Instrument (RAI) process within the facility, ensuring accurate assessments and compliant reimbursement across Medicare, Medicaid, OBRA, and payer programs.

The role requires leadership of the RAI/MDS workflow, mentoring an Interdisciplinary Team, and close collaboration with billing and QA to optimize 5-Star outcomes and regulatory compliance.

Qualifications

• Active RN license in Michigan is required.
• Minimum five years of clinical experience, with two years in long-term care preferred.
• Experience with RAI/REs and MDS processes preferred.
• AANAC certification preferred.

Responsibilities

• Coordinate RAI/MDS processes for accurate assessments and compliant billing.
• Lead IDT communications and PPS/Medicare meetings.
• Ensure CMS/OBRA/payer requirements adherence.
• Coach and mentor staff on RAI/QA processes.

Skills

Mentoring IDT

RAI knowledge

Communication

Leadership

Education

Registered Nurse license (Michigan)

AANAC certification

Tools

PointClickCare

Job description

Sign on Bonus $10,000.00

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.

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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