Regional MDS Manager - Denver, United States - Beecan Health

Description

Job Description

Are you a person who believes in providing great care? Do you believe in having a positive impact on other people's lives? Are you a team-player, quick-thinker, and ready to be a part of an organization that supports your growth?

WHAT WE'RE ABOUT

We believe care goes beyond a medical chart. With kindness and integrity as our guide, we strive for excellence in every interaction.

Requirements:

You care.

MDS Manager Perks:

• Generous Bonuses
• Growth Opportunities
• Health Benefits
• 401K

Summary: Provides education, consultation, expertise, and service regarding Clinical reimbursement systems within VivageBeecan homes and other contracted projects. This position requires expertise in MDS, PPS and RAI processes and the ability to affect solutions to identified issues and problems. Responsibility includes accurate and timely completion of all Medicare, Medicaid case mix documents to assure appropriate reimbursement for services provided within the organization. Must possess a basic knowledge of billing, cost containment procedures, ancillary management, quality assurance and utilization management.

Region: Southern Colorado

ESSENTIAL FUNCTIONS:

• Provide onsite consultation and facilitation for the development of maximizing accurate reimbursement through the MDS systems
• Educates and trains team members on Medicare guidelines for reimbursement and updates on changes affecting reimbursement.
• Education and training of MDS policy and procedures, RAI process and survey support
• All payer review and training to ensure compliance with reimbursement structure as well as integrating clinical expectations
• Regulatory consultation and oversight as well as interdisciplinary management of systems for denial management
• Mentors new Clinical Reimbursement Coordinators to increase their knowledge in MDS/RAI and Clinical Reimbursement systems
• Reports data and participates in monthly Community Operational Reviews as requested by Director of Clinical Reimbursement
• Reports growth and changes within the teams as it relates to all payor types for improved outcomes
• Acts as a resource for Clinical Reimbursement Coordinators and facility Interdisciplinary team regarding clinical computer related issues and education
• Onsite audit and review of reimbursement systems as well as analysis and action plan implementation
• Clinical software support for all VivageBeecan Communities including data scrubbing and compliance as it pertains to the RAI regulations
• Analyzes reimbursement strategies implemented in the facilities and reports on the outcomes of those strategies
• Audits medical record documentation to validate that the documentation supports delivery of service and utilization being billed with supportive MDS coding.
• Monitors the cost of services prior to delivery and manages duplicate or unnecessary services in collaboration with physicians and interdisciplinary team to preserve revenue and prevent excessive costs of case mix
• Identifies educational needs related to the MDS/RAI process and participates in training as appropriate
• Reviews Center Operations billing review (Triple Check) by reviewing diagnosis coding on MDS, medical record and billing statement to reduce billing errors and ensures appropriate documentation to support medical review
• Manages Case mix for optimum strategies including evaluation and quality of systems
• Provides feedback to Reimbursement, Financial, and Clinical systems to meet operational outcomes
• May be required to fill in as a Clinical Reimbursement Coordinator at a Community to maintain compliance with or without notice
• Performs other duties as requested

OTHER DUTIES:

• Attend State and National Conferences and other trainings to further knowledge of developments in Nursing assessment, regulatory changes, reimbursement and therapy procedures
• Assist with coordination of quarterly meetings with Clinical Reimbursement Coordinators and back up MDS coordinators regarding outcomes, training of new information and growth opportunities.
• Attend quarterly VivageBeecan Operations and Clinical meetings as needed
• Implement trainings for all team regarding reimbursement opportunities within the homes and strategizes their success.
• May present to other organizations and conferences as requested on Clinical Reimbursement items
• Maintains CASPER access and can work in collaboration with Clinical Services on Quality Measure tracking, analysis and improvement
• Perform all other duties, as assigned.

SKILLS AND KNOWLEDGE:

• Basic computer skills required, including knowledge of Microsoft Office, Internet search methods, Google, PointClickCare and other software as needed
• Must be proficient in Medicare, Medicaid, Managed Care regulations including case mix reimbursement and RUG IV knowledge in a skilled nursing environment
• Demonstrates excellent communication and presentation skills, oral, and written
• Demonstrates strong interpersonal skills and ability to work well in a team environment meeting deadlines
• Maintains a strong working knowledge of the Resident Assessment Instrument (RAI) Manual
• Extensive knowledge of MDS software as well as MDS state and federal regulations utilizing MDS 3.0 and RUGS IV
• Proven track record of revenue building from all payer types as well as development of systems to reduce risk and increase efficiency
• Leadership skills with proven experience of building teams and implementing processes

EXPERIENCE:

• Must demonstrate ability to communicate complex topics to all education levels
• Creating tools for systems audit
• Public speaking
• Long Term Care
• Care Plan and software knowledge
• Management of multi sites and systems
• Must possess a basic knowledge of billing, cost containment, per diem rates, ancillary costs and utilization management
• Superior clinical assessment and documentation skills

EDUCATION

• Highschool diploma or GED

WORK ENVIRONMENT:

• Moves intermittently during working hours
• Is subject to frequent interruptions
• Is involved with residents, personnel, visitors, government agencies/personnel, etc., under all conditions and circumstances
• Is subject to hostile and emotionally upset residents, family members, etc
• Works beyond normal duty hours, on weekends, and in other positions temporarily, when necessary
• Is subject to call back during emergency conditions (e.g., severe weather, evacuation, post-disaster, etc.)
• Is subject to injury from falls, burns from equipment, odors, etc., throughout the workday, as well as reactions from dust, disinfectants, tobacco smoke, and other air contaminants
• Is subject to exposure to infectious waste, diseases, conditions, etc., including TB and the AIDS and Hepatitis B viruses
• May be subject to the handling of and exposure to hazardous chemicals

PHYSICAL AND SENSORY REQUIREMENTS:

• Regularly required to talk and hear.
• Specific vision abilities including close vision, color vision, and ability to adjust focus.
• Prolonged periods of sitting at a desk and working on a computer.
• Ability to occasionally lift office products and supplies, and recruitment materials up to 25 pounds.
• Ability to travel, sometimes for extended periods of time including driving considerable distances
• Ability to conduct all day training sessions
• Must be able to communicate tactfully when personnel, residents, family members, visitors, government agencies/personnel and the general public
• Moves intermittently during working hours
• Is subject to frequent interruptions
• Works beyond normal duty hours, on weekends, and in other positions temporarily, when necessary

Must Haves:

• Proof of COVID vaccination or qualifying exemption required
• Must be willing to travel. Not a remote position.
• Prior MDS experience of >3 years
• Multi-site consultation in MDS preferred
• Colorado RN license required, willing to be RAC-CT certified within 6 months