Under the supervision of the Director of Nursing, the MDS Coordinator will assure that the correct and compliant utilization of Medicare and Medicaid services is maintained. Complete accurate and timely MDS assessments for all residents. Coordinate tracking of Medicare and Medicaid data and educates facility staff on Medicare and Medicaid rules and regulations. Demonstrate expertise with PDPM. Use your excellent assessment skills to develop care plans individualized to meet residents’ needs. Routinely audit to verify facility is following Federal and State rules and regulations and established policies and procedures.
- Educates new and current facility staff on established Medicare and Medicaid policies and procedures.
- Audits of facility for compliance with established Medicare and Medicaid policies and procedures and rules and regulations.
- Assists with implementing restorative nursing programs.
- Develops and updates Medicare and Medicaid policies and procedures as changes occur.
- Assists facility with development of Action Plans to correct issues identified through audits and develop systems to maintain compliance.
- Works in concert with interdisciplinary team to develop individualized care plans to meet the residents needs.
- Audits the medical records, Medicare non-coverage letters and Physician Certification and re-certification for accuracy and completion.
- Facilitates triple check and audits a sample of the UB-04’s and compares to the medical record to verify the medical record supports the claim.
- Monitors ADL documentation for compliance.
- Monitors the Nursing Restorative Log.
- Assists the facilities in Medicare and Medicaid utilization and compliance and ADR’s/Denials.
- Participates in state Medicaid audits and is knowledgeable of state specific regulations.
- Complete MDS per RAI.
- Maintains a current, valid license as an RN; BSN preferred, and is in good standing. Possesses strong knowledge of state, federal, and local regulations as they pertain to long-term care.
- Possesses a minimum one (1) year of experience in Nursing Service Administration. Additional education or experience in such areas of rehabilitative or geriatric nursing is preferred.
- Demonstrates knowledge of age specific developmental factors specific to adult and geriatric residents (i.e., physical, cognitive, and socialization factors) as it applies to clinical reimbursement.
- Demonstrates strong knowledge of the Medicare PDPM, Medicaid and documentation guidelines.
- Demonstrates knowledge of analyzing and tracking the Case-Mix Roster report and making recommendations accordingly.
- Is knowledgeable of MDS coding as defined in the RAI Manual. Educates facilities on correct coding and selection of MDS assessments for payment. Expertise in PDPM.