MDS Coordinator

Wedgemere Healthcare is seeking a highly skilled MDS Coordinator to join our team. As a key member of our healthcare operations team, you will play a critical role in ensuring the accurate and timely completion of resident assessments in accordance with Medicare, Medicaid, OBRA, and other payer program requirements.

• Ensure timely, accurate, and complete assessment of the resident's health and functional status during the entire assessment period.
• Ensure accurate and timely completion of all Medicare/Medicaid case-mix documents in order to assure appropriate reimbursement for services provided within the facility.
• Collaborate with the facility Director of Rehab to ensure the most appropriate assessment reference date (ARD) is utilized for Medicare/Managed Care Assessments.
• Track Skilled (MRA/HMA/HMO) customers utilizing Case Management Tools to determine continued and appropriate Medicare/Managed Care eligibility and benefit period through regular communications with Clinical Reimbursement Specialist, Business Office, and external Case Managers.
• Ensure that additional requirements of the Medicare Program are met, such as Physician certification and re-certification.
• Perform concurrent MDS review to assure appropriate RUG/PDPM category is achieved through the capture of appropriate clinical information.
• Participate in the interdisciplinary team process to communicate opportunities, facilitate efficient and effective care plan development and management.
• Ensure the accurate and timely completion of all MDS assessments, including PPS, scheduled and unscheduled, Admission, quarterly, annual, and significant change.
• Collaborate with the interdisciplinary team to identify significant change in status and implementation of Significant Change in Status MDS.
• Maintain an accurate schedule of all MDS assessments to include the proper reference dates throughout the residents stay.
• Track, record, and analyze all default days and rectify if appropriate. Implement corrective action to prevent further default action.
• Perform Modifications/Inactivation's of assessments in accordance with CMS Correction Policy and collaboration with Clinical Reimbursement Specialist.
• Conduct regular audit of MDS process, including validation of coding documentation.
• Ensure the timely electronic submission of all Minimum Data Sets and secure backup personnel to complete this process.
• Review the validation reports and ensure that appropriate follow-up action is taken.
• Review Late/Missed assessment reports monthly and address issues as appropriate.
• Communicate with the Business Office and Administrator on a regular basis regarding RUG/PDPM distribution, default days/unassigned days, case mix index (if applicable).
• Review discharged managed care with BOM on a weekly basis.
• Participate in month-end Triple Check and other meetings per Next Step Healthcare's policy.
• Facilitate Case Management meeting per Next Step Healthcare's policy.
• Function as an RAI and Clinical Reimbursement resource to the facility staff.
• Utilize Relias annual competency training as well as for educational resource as needed.
• Assist in the orientation and training of new associates on the RAI process and ensure the dissemination of any new or updated materials regarding the RAI and/or Federal and State regulations.
• Ensure timely RN coordinator signatures.

• Must be a graduate of an accredited school of nursing with current RN or LPN licensure in the state in which employment occurs.
• Minimum of two years health care experience.
• Experience with MDS completion, reimbursement, clinical resource utilization, and/or case management is highly desirable.
• Ability to work flexible work hours to support business requirements.
• Complete and pass all Next Step Healthcare specific MDS/RUGs training modules (Relias) within the first 90 days of employment and ongoing per company policy.
• Competency with standard office software applications as well as software applications related to MDS/RAI processes.
• High initiative and ability to efficiently and effectively lead interdisciplinary teams and coordinate and manage RAI process.
• Ability to utilize both local and corporate resources in the execution of job responsibilities.

• Customer Service Oriented
• Ability to be patient while interacting with challenged or difficult residents
• Demonstrates organizational and critical thinking skills
• Strong interpersonal skills
• Ability to work independently, problem solve, and make decisions as necessary
• Ability to create a resident-centered environment
• Knowledge of policies and procedures and state and federal regulations