Reviews medical records, physician documentation, diagnoses, orders, treatment plans, therapy documentation, and supporting clinical evidence to ensure accuracy of MDS coding.
Oversees ICD-10 diagnosis validation, coding accuracy, diagnosis mapping, and physician query processes.
Coordinates completion of resident interviews, including BIMS, PHQ, pain interviews, SDOH assessments, and other federally required components, in collaboration with facility staff.
Provides teaching and training for MDS item completion to interdisciplinary team members who have responsibility for completing MDS items.
Collaborates with nursing, therapy, social services, dietary, activities, medical records, business office, and providers to ensure resident needs and reimbursement opportunities are appropriately identified and documented.
Tracks and manages assessment schedules, ARDs, interrupted stays, IPA opportunities, certification and recertification requirements, and regulatory deadlines.
Conducts audits to identify documentation, coding, compliance, or reimbursement opportunities and develops corrective action plans.
Facilitates IDT discussions regarding functional decline, therapy referrals, resident outcomes, quality measures, and reimbursement.
Maintains expertise in CMS regulations, RAI Manual guidance, PDPM reimbursement methodology, Nevada Medicaid Case Mix requirements, and other applicable regulatory requirements.
Provides education, mentorship, and ongoing training to facility staff regarding MDS processes, documentation requirements, reimbursement systems, and regulatory updates.
Partners with facility leadership to analyze trends, improve systems, and achieve clinical, quality, and financial goals.
Serves as a facility resource for survey readiness, MDS accuracy reviews, reimbursement audits, and compliance initiatives.
Qualifications
Current RN or LVN/LPN license required.
Minimum two years of MDS experience in a skilled nursing facility preferred.
Strong knowledge of Nevada Medicaid requirements, RAI processes, MDS 3.0, Care Area Assessments (CAAs), and care planning requirements.
Advanced knowledge of PDPM reimbursement methodology and Medicaid Case Mix processes.
Demonstrated competency with Quality Measures (QMs), Quality Reporting Program (QRP), Case Mix Reviews (CQR), Medicare and Medicaid reimbursement systems, and regulatory compliance.
Experience leading interdisciplinary teams and facilitating meetings involving nursing, therapy, social services, and other departments.
Proven ability to organize processes, establish accountability, and drive operational results.
Strong analytical, auditing, communication, and leadership skills.
Experience with ICD-10 coding, physician query processes, and clinical documentation review preferred.
Proficiency with electronic medical records, MDS software platforms, and reimbursement reporting tools.
Benefits
401(k)
401(k) matching
Dental insurance
Employee discount
Flexible spending account
Health insurance
Health savings account
Life insurance
Paid time off
Relocation assistance
Vision insurance
For benefit details check us out here http://ensignbenefits.com/
Benefits eligibility for some benefits dependent on full time employment status.
Disclaimer: Pay rates are competitive and determined by various factors. Please note that any rates labeled as "estimated" are provided by third-party job boards and may not accurately reflect the actual pay rates.
EOE disability veteran
