POSITION PURPOSE:

• Responsible for the timely and accurate completion of the MDS process from admission to discharge. Coordinate information systems operations and education for the clinical department.
• MOD obligation: In the presence of a structured/formal Manager on Duty agenda with paid overtime as necessary. (This is because it is not realistic in most situations to provide for alternate time off in a position such as this)

ESSENTIAL FUNCTIONS OF POSITION:

• Review of all Medical Records and interview with patient/family/RP to ensure all comorbidities are documented. If needed communicate with Physician to obtain an order for patient’s chart.
• PPS - Determination of Skilled need and appropriate category and primary ICD 10 code.
• Review of hospital documentation for case mix optimization for all admit, readmit, ER visits.
• Strategic ARD selection related to payer.
• ICD 10 Coding for all of patient’s diagnosis.
• Mapping/sequencing ICD 10 Codes for all Part A, MGD Care and Part B.
• Check ADL coding daily for accuracy and holes. Educate staff when needed.
  • Accurate coding per the RAI Manuel for Section G (OBRA) and GG (PPS)
• Timely and strategic Completion MDS sections as IDT staffing dictates (no SW, ACT, RD because of vacancy or vacation).
• Chart audit for and IDT notification of missing DX, MD visits, IDT notes, Nursing documentation, possible incidents etc. during MDS completion.
• IDT coordination for timely MDS completion. The expectation is that the assessment be completed the day after the ARD.
• TSI alerts with the close of each MDS.
• Address areas from TSI as necessary.
• Review all Scrub Reports daily with the IDT during daily clinical meeting.
  • Correct any coding that was determined to be inaccurate during IDT collaboration.
• MDS modification as appropriate.
• CAA completion per the RAI Manual.
• Detailed and personalized Care Plan development from comprehensive assessment and revision with other scheduled MDS assessments.
• Ensure that Care Plans are updated by the team daily during the clinical meeting. IDT approach.
• Weekly review of P, B and I RUGs in case mix states using the TSI Medicaid Check Report.
• Case mix optimization as relates to setting early ARDs determining completion dates, use of weekly TSI Medicaid Check Report.
• Send worked TSI Medicaid Check Report to RRN every Friday.
• Daily IDT Skilled Meeting with IDT.
• Weekly UR prep and meeting with IDT for Part A and B.
• Weekly Part B Log.
• Pull DCR report to address any ZZZ or missing RRR RUG values and alert BOM to concerns.
• Completion and compliance with Physician certification for Medicare.
• Assist with determination of Medical Necessity prior to admission to facility (TX)
• Completion of Continued Skill form monthly for Central Billing.
• Completion and delivery of denial letters for residents cut with remaining days, and other denial situations in the absence of a trained BOM and/or SW.
• Identification/Collection of MDS specific documentation for ADRs and review of ALL documentation prior to sending to the Appeal Department.
• Monthly QA meeting (expected to pull Casper reports 1-week prior for IDT analysis)
• EOM billing preparation and MRA assessment completion with response to RRN preliminary findings.
• Monthly Triple check meeting and completion of validation report as additional MDS completed.
• LTCMI completion and submission within 48* (TX).
• Check Simple at least weekly and follow up with any needs. Communicate with the BOM when necessary.
• Weekly Level of Care Meeting (TX).
• Call on any Pending Denial within 5 working days.
• Notify RRN of any PCE needs so that correct dates can be verified.
• Oversight and licensed documentation related to developed Restorative Nursing Programs.
• Review of preliminary Case mix reports from M&S with correction and submission for finals. (LA, CO, NV).
• Ongoing Managed care review/update.
• Bi - Weekly Transmission of MDS.
• Weekly review of Submission file to address rejections or warnings.
• Monthly review of Missing Assessment Report from CMS.
• Assist with education related to documentation.
• ALL OTHER DUTIES AS ASSIGNED BY SUPERVISOR

PCC is not responsible for:

• New Admission chart reviews as relates to clinical compliance. Can assist with this during the clinical meetings.
• MD order monthly review
• PASSR – depending on each facility’s need.
• Managed Care preauthorization
• Completion of UDAs
• 802/672 management

EDUCATION / REQUIREMENTS:

RN licensure within the State plus a minimum of two years MDS experience in long term care; or equivalent combination of education and experience. LVN or LPN may be considered with exceptional qualifications and CEO/CNO review and approval. Prefer RAC-CT certification. Must pass MDS competency test within 90 days of hire. Must demonstrate the knowledge and skills necessary to prove care appropriate to the age-related needs of the residents served. Must be a supportive team member, contribute to and be an example of teamwork and team concept. Must possess the ability to make independent decisions when circumstances warrant such action. Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the general public. Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations and guidelines that pertain to long term care facilities. Must be organized and be able to meet deadlines.

This position is a deadline driven financial position with a clinical background.