The Corporate MDS/Reimbursement Specialist is responsible for the oversight and support of the RAI process of three skilled nursing facilities in Texas (Pasadena, Mont Belvieu, and Trinity). This specialist will work with the facility reimbursement team, consisting of the MDS Coordinator, Restorative Nurse Aide, Rehabilitation Director and Business Office Manager, to ensure maximum reimbursement, favorable QM/QI results, positive QIPP scorecard outcomes while following the RAI process according to state and federal rules and regulations.
We are seeking an experienced, reliable, self-starting candidate who is able to demonstrate a record of achieving excellence in Quality Measures, MDS accuracy and maximized reimbursement to oversee, guide, monitor and educate MDS Coordinators in 3 skilled nursing facilities (Pasadena, Baytown and Trinity). The candidate we seek must have a current, unencumbered Texas nursing license (LVN or RN) or the ability to practice nursing in Texas through multi-state licensure without restrictions, a current Resident Assessment Coordinator (RAC) certification, Texas RUG certification, and be able to demonstrate a sound knowledge of the Texas reimbursement process (LTCMI/MESAV) and PASRR procedures. A qualified applicant will have a history of employment/leadership in the long-term care environment with a strong working knowledge of regulatory and payer requirements for reimbursement and for denial of claims for all payer sources.
The talents and attributes listed below are the expectations of this position:
*The ability to work independently while managing time/duties with minimal oversight while managing tasks to meet deadlines by re-prioritizing workflows without supervisory direction
*Flexibility with the ability to travel to nursing facilities as needed/directed with minimal notice to address immediate issues, regulatory visits, training, or assumption of the interim MDS Coordinator as needed.
*The ability to communicate professionally in-person and in writing, demonstrating capableness in listening and getting clarification.
*The ability to function as part of the clinical team and work with facility staff to promote high-quality care and regulatory compliance.
*Capability to be dependable, following instructions and responding to direction; taking responsibility for own actions; keeping commitments and completing tasks on time or notifying appropriate person with alternate plan.
*Wherewithal to display character that demonstrates integrity and honesty in every aspect of work and dealing with others; consistently modeling the desired behaviors and values of the company respecting diversity of perspective in discussions while demonstrating a style of inclusiveness; promoting job safety for self and others.
The duties listed below are specific to the Corporate MDS/Reimbursement Specialist:
*Providing guidance, training, and support to the facility level MDS nurses and staff, helping them maintain accurate and timely documentation, ensuring compliance with federal and state regulations, and improve patient care outcomes.
*Conducting periodic, detailed audits of the RAI process, including MDS assessments, care plans, and LTCMI to ensure compliance and identify areas for improvement and working closely with facility leadership to implement suggested improvements.
*Proficiently assist with comprehensive review and production of supporting medical records in response to Medicare, Medicaid, and managed care/insurance audits/appeals; risk adjustment/quality reviews; requests made by State and Federal surveyors; OIG auditors
*Monitoring the facility’s QI and QM reports to ensure that appropriate corrective action can be implemented when potential problems areas occur.
*Assisting the clinical team in periodically updating written policies and procedures that govern the development, use, and implementation of the resident assessment (MDS) and care plan.
*Developing, implementing, and maintaining an ongoing quality assurance program for the resident assessment/care plans.
*Participating in facility surveys (inspections) made by authorized government agencies.
*Other duties as directed by the Chief Executive Officer and/or Director of Clinical Operations.
Environmental and physical requirements:
*Walking, reaching, bending, lifting, extended sitting, extended standing, grasping, fine hand coordination, pushing and pulling, ability to distinguish smells and temperatures, all with or without the aid of mechanical devices.
*The ability to travel to each facility with limited notice.