PT-MDS

Indigo Manor Nursing and Rehab - SummaryResponsible for the coordination of the Resident Assessment Instrument (RAI) process to ensure accurate and timely completion of resident assessments in accordance with Medicare, Medicaid, OBRA and other payor program requirements. Ensures assessments accurately reflect the physical, mental and psychosocial status of each resident; ensures appropriate documentation to report and support services provided and assessment accuracy. Communicates effectively with other members of the interdisciplinary team. Follows all the company policies and procedures.Essential Job Duties and Responsibilities1. 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/Inactivation 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 Duties1. 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.Qualifications1. 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.