MDS Coordinator RN/LVN — Reimbursement & Compliance Lead

Cantex Continuing Care Network; Plano (TX); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

401k with match

Medical, Dental, Vision & Supplemental

Vacation, Sick, Personal Holiday &Paid

Short-Term Disability

Life Insurance

Tuition & CEU Reimbursement

Rewards & Recognition Program

Job summary

Cantex Continuing Care Network in Plano, TX is seeking an MDS Coordinator to manage the MDS/RAI process and support Medicare/Medicaid reimbursement while ensuring high-quality patient care in accordance with regulatory standards.

Responsibilities include ensuring compliance with state and federal rules, coordinating the weekly reimbursement meeting, auditing clinical records, obtaining qualifying diagnoses, and training staff on documentation to optimize care and billing accuracy.

Qualifications

• MDS experience and knowledge of the RAI process.
• Texas RN/LVN license in good standing is required.
• Onsite LTC experience preferred.
• Must complete AANAC RAI Certification within 12 months.
• Must complete HHSC RUG Online Training for Nursing Facilities."

Responsibilities

• Maintains compliance with all State and Federal Medicaid and/or Medicare rules, regulations, and published interpretations.
• Participates in the assessment of pre-admission paperwork to ensure Patient meets qualifying medical necessity determination.
• Attends standup meetings every weekday morning.
• Coordinates the Weekly Reimbursement Meeting with Interdisciplinary Team Members to ensure proper Medicare/Medicaid reimbursement to match care delivery.
• Audits the Clinical Record to ensure appropriate documentation for actual care delivery; educates staff on documentation guidelines.
• Obtains Medicare qualifying diagnoses for Part A patients and updates diagnoses as needed.
• Initiates and updates physician certifications for each Medicare Part A patient.
• Completes all MDS assessments within required timeframes for Medicare/Medicaid patients.
• Reviews 24-hour Nursing report to detect changes in patient condition.
• Prepares for Medicaid audits.
• Tracks patient benefit days, validates daily census, and coordinates with Financial Manager for accurate billing.
• Strives to achieve budgeted rate targets.

Skills

MDS experience

Texas nursing license

LTC experience

AANAC RAI certification

HHSC RUG training completion

Analytical/reporting

Job description

Cantex Continuing Care Network in Plano, TX is seeking an MDS Coordinator to manage the MDS/RAI process and support Medicare/Medicaid reimbursement while ensuring high-quality patient care in accordance with regulatory standards.

Responsibilities include ensuring compliance with state and federal rules, coordinating the weekly reimbursement meeting, auditing clinical records, obtaining qualifying diagnoses, and training staff on documentation to optimize care and billing accuracy.