MDS Auditor/Specialist

Description

Come join us in living out our vision of Reconnecting People to Life. 

SUMMARY

To ensure that the MDS assessments are completed/coordinated in a timely and accurate manner that is in compliance with all federal and state regulations.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Assist in the oversight and mentor ship of MDSCs to ensure compliance and integrity of the MDS program.

• Hold regional Focus calls for facilities requiring close oversight. Conduct follow-up and document progress on all areas of concern identified.

• Conduct regular chart audits focused on MDS regulatory compliance and coding accuracy; identification and provision of additional MDSC education. Submit audit findings to facility Administrator, Director of Nursing, and MDS Coordinator.

• Conduct monthly facility audits to include completion of: General chart audits and MDS audits to ensure compliance with Company Medicare Process. Provide training and education in identified areas of weakness.

• Submit a Summary report identifying areas of opportunity or concern for each facility to Regional Director of Operations, with copies to Senior Director of Clinical Services as needed to address areas of concern.

• Maintain open communication with Senior Director of Clinical Services concerning upcoming changes in MDS rules/Documentation needs/patterns of concern/etc.

• Work closely with the Accounts Receivable department to assist with ensuring the accuracy in billing at month end.

• Monitoring of: o RUGS trends. o ALOS. o ADL Coding accuracy. o Identification and resolution of date integrity issues.

• Assist facilities in identification and resolution of negative MDS & Medicare trends.

• Assist facility Administrators in evaluations and remote training of MDS Coordinators.

• Verify accuracy of dates of services and assigned RUGS along with acceptance of MDS assessments in CMS repository through regular inspection of CMS Validation Reports prior to billing as part of Triple Check Process.

• Conduct consistent training in the following areas:

o ADL Coding training. o New MDSC Basic RAI training.

o Interdisciplinary Team training on the MDS process.

o CMS compliance policy training.

o Annual changes due to Final Rules.

o CAAs and Care Plans.

o Medicare Process/Manual.

o Medicaid Case Mix- MS homes.

• Provide supplemental MDSC support during times of sudden census increase.

• Monitor for skilled documentation to support medical necessity of inpatient skilled services.

• Identify reimbursable services that are being provided but not captured on the MDS.

• Monitor and stay up to date with changes in regulations as related to the MDS and clinical documentation requirements

• Consult, advise, and assist the Senior Director of Clinical Services with projects, initiatives, and task.

Requirements

EDUCATION and/or EXPERIENCE

• Licensed Nurse.

• Minimum of 3 years’ experience in MDS in long term care or equivalent combination of education and experience required.

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*KNOWLEDGE, SKILLS AND ABILITIES *

• Excellent written and verbal communication skills.

• Outgoing and energetic personality.

• Ability to multi-task while being detail-oriented.

• Intermediate computer skills.

• Experience with MS Office Word, Excel, and PowerPoint preferred.

• Experience with PointClickCare preferred.