MDS Director

Capitol Hill Healthcare; Prattville (AL); On-site; USD 65,000 - 95,000; Full time

Job summary

Capitol Hill Healthcare seeks a Clinical Reimbursement Director for our Skilled Nursing Facility to oversee MDS/PDPM processes and ensure timely, compliant assessments. You will coordinate MDS data collection, coding, and documentation in collaboration with an interdisciplinary team.

The role focuses on reimbursement optimization, staff education, and quality assurance, requiring strong analytical skills, attention to detail, and proficiency with MDS software and EHR systems.

Qualifications

• RN licensed to practice in Alabama.
• In-depth knowledge of the MDS assessment process, PDPM guidelines, and reimbursement regulations.

Responsibilities

• Oversee the MDS process and ensure timely completion of assessments.
• Collaborate with interdisciplinary team to develop care plans based on MDS findings.
• Audit MDS documentation for accuracy and compliance with regulations.
• Analyze MDS and coding data to optimize PDPM reimbursement.
• Educate staff on MDS requirements and PDPM documentation best practices.

Skills

MDS coordination

PDPM knowledge

RN experience

Regulatory knowledge

Data analysis

EHR systems

Education

RN license

Tools

MDS software

EHR systems

Job description

The Clinical Reimbursement Director in our Skilled Nursing Facility (SNF) oversees and coordinates the Minimum Data Set (MDS) process and ensures accurate and timely completion of the MDS assessments. Additionally, the PDPM Coordinator/MDS Coordinator is crucial in managing the Patient-Driven Payment Model (PDPM) to optimize reimbursement and support the facility's financial goals.

Key Responsibilities

• MDS Coordination: Oversee the MDS process and ensure compliance with state and federal regulations. Coordinate and manage the completion of the MDS assessments, including the initial, significant change, quarterly, and annual assessments, in collaboration with the interdisciplinary team.
• PDPM Management: Understand and stay updated on the PDPM guidelines and requirements. Collaborate with the interdisciplinary team to ensure accurate coding and documentation to support appropriate reimbursement under the PDPM system.
• Assessment and Documentation: Review residents' medical records, observe their conditions, and interview residents and their families to gather necessary information for MDS assessments. Accurately complete MDS assessments and other required documentation within designated timeframes.
• Care Plan Development: Collaborate with the interdisciplinary team to develop individualized care plans based on MDS assessments and residents' needs. Ensure care plans are regularly reviewed, updated, and implemented to support quality care and maximize resident outcomes.
• Quality Assurance: Conduct audits and quality checks on MDS assessments and documentation to ensure accuracy, completeness, and compliance with regulations. Identify areas for improvement and provide education and training to staff as needed.
• Interdisciplinary Collaboration: Work closely with the nursing staff, therapists, social workers, and other healthcare professionals to gather information, share updates, and ensure accurate and comprehensive assessment and documentation of residents' conditions and care needs.
• Reimbursement Optimization: Analyze MDS assessments, coding, and documentation to identify opportunities for optimizing reimbursement under the PDPM system. Collaborate with the financial team to monitor reimbursement trends, address coding and documentation issues, and maximize financial outcomes.
• Staff Education: Provide education and training to staff on MDS assessment requirements, coding guidelines, and PDPM documentation best practices. Stay updated on changes in regulations and guidelines and communicate them to the interdisciplinary team.
• Compliance: Ensure compliance with federal and state MDS assessments, documentation, and reimbursement regulations. Stay informed about changes in regulations and guidelines and implement necessary updates in MDS processes and documentation practices.
• Data Management and Reporting: Collect and analyze data related to MDS assessments, reimbursement, and resident outcomes. Generate reports and communicate findings to the management team, highlighting areas for improvement and strategies for enhancing resident care and financial performance.

Preferred Qualifications and Skills

• Registered Nurse (RN) required.
• In-depth knowledge of the MDS assessment process, coding guidelines, and federal regulations related to MDS and reimbursement (e.g., PDPM).
• Prior experience in MDS coordination and familiarity with MDS software systems.
• Strong understanding of the PDPM payment model and its impact on reimbursement in the SNF setting.
• Excellent analytical skills and attention to detail in assessing, coding, and documenting resident information.
• Proficient in using computer software and applications for data management and reporting.
• Ability to collaborate effectively with the interdisciplinary team and communicate complex information to staff members.
• Strong organizational and time management skills to meet MDS assessment and reporting deadlines.
• Knowledge of quality assurance and performance improvement principles.
• Familiarity with electronic health record (EHR) systems and healthcare technology.
• Ability to adapt to changes in regulations and guidelines related to MDS and reimbursement.