Regional MDS & Reimbursement Coordinator

OPCO Skilled Management; Fort Worth (TX); On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Healthcare

Dental

Vision

PTO

401k

Job summary

OPCO Skilled Management is seeking a Director of Medicaid Reimbursement for long-term care facilities in Texas. You will lead PPS, TILE and MDS accuracy reviews to optimize Medicaid reimbursement and ensure regulatory compliance across centers.

In this role you will train Directors of Nursing and business office staff, review 3652 forms, coordinate with QA, and participate in center reviews with the Regional VP.

Qualifications

• Current nursing license in the state in which practicing.
• Strong organizational and mathematical skills.
• Strong verbal and written communication skills.
• Experience in long-term care Medicaid reimbursement, PPS, MDS and QI; Nursing Director experience preferred.

Responsibilities

• Is an integral part of the management teams and works hand-in-hand with the Regional Vice President and QA Nurses to clinically support the facility.
• Provides in-service and training on QI/PPS/Medicaid reimbursement.
• Reviews medical records for accuracy for QI, MDS, and PPS.
• Review findings of state Medicaid reviews for accuracy.
• Completes the nursing portion of the ADRs as indicated by the state’s review of PPS.
• Reviews all resident charts monthly for changes affecting TILE, PPS, reimbursement, MDS and QI.
• Provides training to licensed staff on documentation to support PPS and TILE levels.
• Provides training to Directors of Nursing and nurse assessors on 3652 forms and MDS.
• Provides training to business office managers on tracking levels of care for TILES and PPS.
• Reviews TILE level changes by TDHS reviewers and submits documentation for changes deemed inaccurate.
• Reviews PPS levels and IQ Indicators.
• Reviews monthly resident status reports to ensure TILE levels match calculated TILE levels.
• Determines reasons for expired levels of care and investigates causes.
• Reviews transmitted 3652 forms for accuracy and assists in transmission as needed.
• Reviews MDS and QI for accuracy and assists in PPS submission.

Skills

Organizational skills

Mathematical skills

Communication skills

Medicaid PPS MDS QI

Education

RN license

Job description

OPCO Skilled Management is seeking a Director of Medicaid Reimbursement for long-term care facilities in Texas. You will lead PPS, TILE and MDS accuracy reviews to optimize Medicaid reimbursement and ensure regulatory compliance across centers.

In this role you will train Directors of Nursing and business office staff, review 3652 forms, coordinate with QA, and participate in center reviews with the Regional VP.