Windsor Lane Health Care in Gibsonburg, Ohio is seeking an experienced RN MDS Coordinator. The primary purpose of this position is to coordinate the RAI process assuring the timeliness, and completeness of the MDS, CAA’s, and Interdisciplinary Care Plan.

• MDS scheduling and completion per RAI guidelines including coordinating care plan development and completion with the interdisciplinary team
• Develop an individualized, comprehensive resident care plan with the interdisciplinary team to ensure care area triggers are addressed
• Ensure care plans are reviewed quarterly and updated as needed to reflect current resident status with individualized problems, goals, and interventions
• Coordinate with other disciplines to ensure timeliness of assigned sections of MDS completion and report noncompliance to Executive Director
• Signature of MDS sections V0200B comprehensive CAA completion and Z0500A MDS completion
• Oversee clinical reimbursement and case management services within the center for Medicare A and B, managed care, insurance, and Medicaid (case mix)
• Direct and oversee the implementation of the companies programs, policies, and procedures related to the RAI process to ensure appropriate care is rendered and appropriate reimbursement is obtained
• Coordinate the timely and effective service delivery for all residents while ensuring quality clinical outcomes with appropriate reimbursement
• Advocate on behalf of the resident and facility for needed resident resources and services
• Provide education to other health care providers, the facility’s care team, and the resident/family on Medicare, Medicaid (case mix), managed care, and MDS completion
• Work as a liaison between the facility, the resident/family, rehabilitation, and other care providers
• Oversee and monitor MDS documentation and charting requirements that support services provided to meet billing requirements including state specific requirements for supportive documentation
• Provide oversight of the medicare and managed care residents, coordinate rehabilitation and optimal recovery, and assist with discharge planning
• Oversee the validation of Medicare entitlement and eligibility for prospective residents
• Complete chart audits to assess the quality of the documentation to support skilled Medicare, managed care, and Medicaid coverage
• Oversee the completion of certifications/recertifications
• Ensure Medicare part A and B services are appropriately billed and meet medicare documentation guidelines
• Oversee the resource utilization of services covered under consolidated billing as well as ancillary costs
• Direct the completion of requests for additional information claims requests and appeal for denied Medicare, managed care, and Medicaid claims
• Possess knowledge of facility managed care contract coverage guidelines, outliers, and contracts to ensure care is provided and billed appropriately
• Act as a liaison with the managed care plan provider to communicate resident needs while representing the interests of the facility and resident
• Ensure compliance with federal and state regulations, as well as the Companies’ policies and procedures regarding state specific case mix

• Participate in facility meetings per policy • Oversee MDS accuracy and pertinent narrative data to support MDS assessment

• Perform other duties as assigned and

Conduct job responsibilities in accordance with the standards set in the code of conduct, policies and procedures, applicable federal and state laws, and applicable professional standards.
Benefits: Medical, Dental, Vision, STD/LTD, 401 K, PTO