MDS

Essential Job Duties and Responsibilities

1. Ensures timely, accurate, and complete assessment of the resident’s health and functional status during the entire assessment period.**

2. Participates in the pre-admission process to ensure essential information needed for MDS/Case Mix optimization is obtained from the referral source(s).

3. Ensures accurate and timely completion of all Medicare/Medicaid case-mix documents in order to assure appropriate reimbursement for services provided within the facility.

4. Works in collaboration with the facility Director of Rehab to ensure the most appropriate assessment reference date (ARD) is utilized for Medicare/Managed Care Assessments.

5. Tracks Medicare customers to determine continued and appropriate Medicare eligibility and benefit period through regular communications with Corporate Clinical Reimbursement department and Business Office.

6. Ensures that additional requirements of the Medicare Program are met, such as Physician certification and re-certification.

7. Performs concurrent MDS review to assure appropriate RUGs category is achieved through the capture of appropriate clinical information. Identifies opportunities to enhance reimbursement.

8. Participates in the interdisciplinary team process to communicate opportunities, facilitate efficient and effective care plan development and management.

9. Ensures the accurate and timely completion of all MDS assessments including PPS 5, 14, 30, 60, 90 day, and unscheduled, Admission, quarterly, annual and significant change.**

10. Collaborates with the interdisciplinary team to identify significant change in status and implementation of Significant Change in Status MDS. **

11. Maintains an accurate schedule of all MDS assessments to include the proper reference dates throughout the resident’s stay.

12. Tracks, records and analyzes all default days and rectifies if appropriate. Implements corrective action to prevent further default action.

13. Performs Modifications/Inactivations of assessments in accordance with CMS Correction Policy.**

14. Conducts regular audit of MDS process including validation of coding documentation, evaluating outcomes, and utilization of Data Integrity Audit reports per company policy.

15. Ensures the timely electronic submission of all Minimum Data Sets and secures back-up personnel to complete this process.

16. Reviews the validation reports and ensures that appropriate follow-up action is taken.

17. Communicates with the Business Office and Administrator on a regular basis regarding RUG distribution, default days/unassigned days, case mix index ( if applicable) and their reimbursement impact.

18. Participates in month end Triple Check and other meetings per The company policy.

19. Assists in the preparation and timely submission of any Additional Development Requests (ADRs), Reconsideration and Administrative Law Judge (ALJ)

20. Functions as an RAI and Clinical Reimbursement resource to the facility staff.

21. Assists in the orientation and training of new associates on the RAI process and ensures the dissemination of any new or updated materials regarding the RAI and/or Federal and State regulations.

Other Duties

1. Maintains current knowledge of reimbursement regulations.

2. Maintains data in an organized, easily retrievable manner.

3. Maintains good personal hygiene and follows dress code requirements.

4. Communicates regularly with the Director of Resident Assessment to discuss identified clinical reimbursement issues.

5. Other duties as assigned or needed.

Qualifications

1. Must be a graduate of an accredited school of nursing with current R.N.** licensure in the state in which employment occurs.

2. Minimum of two years health care experience.

3. Experience with MDS completion, reimbursement, clinical resource utilization and/or case management is highly desirable.

4. Ability to work flexible work hours to support business requirements.

5. Complete all the company specific MDS/RUGs training modules within the first 90 days of employment and ongoing per company policy.

6. Competency with standard office software applications as well as software applications related to MDS/RAI processes.

7. High initiative and ability to efficiently and effectively lead interdisciplinary teams and coordinate and manage RAI process.

8. Ability to utilize both local and corporate resources in the execution of job responsibilities.

Position may be filled by LPN, however specific job functions denoted by “” will require an RN to Coordinate the process as stipulated by Federal Regulations.

Key Competencies

Customer Focus: Is dedicated to meeting the expectations and requirements of internal and external customers; gets first-hand customer information and uses it for improvements in products and services; acts with customers in mind; establishes and maintains effective relationships with customers and gains their trust and respect.

Integrity and Trust: Is widely trusted; is seen as a direct, truthful individual; can present the unvarnished truth in an appropriate and helpful manner; keeps confidences; admits mistakes; doesn’t misrepresent him/herself for personal gain.

Listening: Practices attentive and active listening; has the patience to hear people out; can accurately restate the opinions of others even when he/she disagrees.

Conflict Management: Steps up to conflicts, seeing them as opportunities; reads situations quickly; good at focused listening; can hammer out tough agreements and settle disputes equitably; can find common ground and get cooperation with minimum noise.

Informing: Provides the information people need to know to do their jobs and to feel good about being a member of the team, unit and/or organization; provides individuals information so that they can make accurate decisions; is timely with information.

Drive for Results: Can be counted on to exceed goals successfully; is constantly and consistently one of the top performers; very bottom-line oriented; steadfastly pushes self and others for results.

Problem Solving: Uses rigorous logic and methods to solve difficult problems with effective solutions; probes all fruitful sources for answers; can see hidden problems; is excellent at honest analysis; looks beyond the obvious and doesn’t stop at the first answers.

Building Effective Teams: Blends people into teams when needed; creates strong morale and spirit in his/her team; shares wins and successes; foster open dialogue; lets people finish and be responsible for their work; defines success in terms of the whole team; creates a feeling of belonging in a team.

Language Skills

Must possess excellent verbal and written communication and presentation skills.