Topaz Fiscal Services LLC
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MDS Reimbursement Director
role at
Topaz Fiscal Services LLC
We are seeking a MDS Director of Reimbursement to strategically lead our clinical reimbursement team. Our goal is to be a resource to our communities, providing short-term rehabilitation for a short stay with long term success in addition to providing a variety of skilled services.
Job Summary The MDS Director of Reimbursement is responsible for overseeing Clinical Reimbursement initiatives for the company. Manage and evaluate clinical reimbursement staff, track, trend and identify areas of improvement and opportunities for growth. Ensure that reimbursement structures are managed, evaluated, and capture accurate resource utilization at all facilities levels. Partner with the Clinical, Financial and Rehab teams to develop and enhance clinical reimbursement tools and systems.
Essential Duties and Responsibilities
Develop and implement case management and clinical reimbursement programs.
Review weekly/monthly RUG distribution/reimbursement reports and assist in identification of trends.
Provide instruction to Facility MDS Coordinators on the RAI Processes and Systems.
Track, trend and analyze current RUG scores, CMI on a weekly and monthly basis and report to the management team.
Assist the VP of Clinical Services in developing a plan of action to improve the clinical reimbursement/RAJ functions and processes at the Facilities level.
Serve as the subject matter expert for the Company on all areas related to Clinical Reimbursement and RAI.
Serve as the Corporate Liaison with VP of Rehab, reviewing RUGs utilization, Forecasts, ADL Index and Reimbursement Utilization.
Collaborate with the Company Chief Compliance Officer to ensure adherence to company’s policies and procedures plus Federal and State Regulations.
Partner with Medical Review to ensure accurate ADR information is submitted to fiscal intermediaries.
Maintain current information on OBRA regulations, licensure requirements, and other regulatory and agency standards.
Assess knowledge, skills, techniques, procedures and performance of the nursing MDS and staff as it relates to coding of the MDS and related assessments.
Train the MDS staff on appropriate CAAs and trigger worksheets and assessment reference dates.
Assist in development and implementation of education opportunities.
Routinely visit facilities to review, monitor and audit the quality of coding to reflect nursing care provided to residents.
Coordinate with other functional executives and managers to scope projects, coordinate execution across functions and develop training and educational programs as required. Manage change control.
Participate in the recruitment, evaluation and retention of MDS Staff.
Qualifications
RN/Therapist or completion of a Bachelor’s Degree in a Health Care or related field, consistent with duties.
Five to Ten years of Clinical Reimbursement or MOS experience.
Current knowledge of computer technology and systems.
Extensive knowledge of MOS and backup documentation requirements and state grouper and calculator field related to MOS and state payment.
Extensive knowledge of Medicare reimbursement, RUG IV systems, compliance and eligibility.
Strong project management skills with a record of successful project execution; competence in computer technology and systems needed to manage Medicare/State Case Mix systems.
Five years’ experience in Long Term Care Management.
Effective communication with staff, doctors, and corporate leadership, utilizing diplomacy and discretion.
Travel to other facilities required.
Seniority Level Entry level
Employment Type Full-time
Job Function Finance and Sales
Industries Hospitals and Health Care
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MDS Reimbursement Director
role at
Topaz Fiscal Services LLC
We are seeking a MDS Director of Reimbursement to strategically lead our clinical reimbursement team. Our goal is to be a resource to our communities, providing short-term rehabilitation for a short stay with long term success in addition to providing a variety of skilled services.
Job Summary The MDS Director of Reimbursement is responsible for overseeing Clinical Reimbursement initiatives for the company. Manage and evaluate clinical reimbursement staff, track, trend and identify areas of improvement and opportunities for growth. Ensure that reimbursement structures are managed, evaluated, and capture accurate resource utilization at all facilities levels. Partner with the Clinical, Financial and Rehab teams to develop and enhance clinical reimbursement tools and systems.
Essential Duties and Responsibilities
Develop and implement case management and clinical reimbursement programs.
Review weekly/monthly RUG distribution/reimbursement reports and assist in identification of trends.
Provide instruction to Facility MDS Coordinators on the RAI Processes and Systems.
Track, trend and analyze current RUG scores, CMI on a weekly and monthly basis and report to the management team.
Assist the VP of Clinical Services in developing a plan of action to improve the clinical reimbursement/RAJ functions and processes at the Facilities level.
Serve as the subject matter expert for the Company on all areas related to Clinical Reimbursement and RAI.
Serve as the Corporate Liaison with VP of Rehab, reviewing RUGs utilization, Forecasts, ADL Index and Reimbursement Utilization.
Collaborate with the Company Chief Compliance Officer to ensure adherence to company’s policies and procedures plus Federal and State Regulations.
Partner with Medical Review to ensure accurate ADR information is submitted to fiscal intermediaries.
Maintain current information on OBRA regulations, licensure requirements, and other regulatory and agency standards.
Assess knowledge, skills, techniques, procedures and performance of the nursing MDS and staff as it relates to coding of the MDS and related assessments.
Train the MDS staff on appropriate CAAs and trigger worksheets and assessment reference dates.
Assist in development and implementation of education opportunities.
Routinely visit facilities to review, monitor and audit the quality of coding to reflect nursing care provided to residents.
Coordinate with other functional executives and managers to scope projects, coordinate execution across functions and develop training and educational programs as required. Manage change control.
Participate in the recruitment, evaluation and retention of MDS Staff.
Qualifications
RN/Therapist or completion of a Bachelor’s Degree in a Health Care or related field, consistent with duties.
Five to Ten years of Clinical Reimbursement or MOS experience.
Current knowledge of computer technology and systems.
Extensive knowledge of MOS and backup documentation requirements and state grouper and calculator field related to MOS and state payment.
Extensive knowledge of Medicare reimbursement, RUG IV systems, compliance and eligibility.
Strong project management skills with a record of successful project execution; competence in computer technology and systems needed to manage Medicare/State Case Mix systems.
Five years’ experience in Long Term Care Management.
Effective communication with staff, doctors, and corporate leadership, utilizing diplomacy and discretion.
Travel to other facilities required.
Seniority Level Entry level
Employment Type Full-time
Job Function Finance and Sales
Industries Hospitals and Health Care
#J-18808-Ljbffr