Topaz Fiscal Services LLC · 3 weeks ago
MDS Reimbursement Director
Atlanta, GA
Full-time
Onsite
Mid, Senior Level
5+ years expTopaz Fiscal Services LLC is seeking a MDS Director of Reimbursement to strategically lead their clinical reimbursement team. The role involves overseeing clinical reimbursement initiatives, managing staff, and ensuring accurate resource utilization across facilities.
AccountingBillingBookkeeping and PayrollFinancial Services
Responsibilities
Develop and implements case management and clinical reimbursement programs
Review weekly/monthly RUG distribution/reimbursement reports. assist in identification of trends
Provide instruction to the Facility MDS Coordinators on the RAI Processes and Systems
Track, trend and analyze current RUG scores. end splits. 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 V. P. 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 that accurate ADR information is submitted to the fiscal intermediaries
Maintain Current information on OBRA regulations, licensure requirements, and other regulatory and agency standards
Assesses the knowledge, skills, techniques, procedure and performance of the nursing MDS and staff as it relates to coding of the MDS and related assessments
Trains the MDS staff on the appropriate CAAs and trigger worksheets and assessment reference dates
Serves as the subject matter expert for the company on all areas related to clinical reimbursement
Assist in identification development and implementation of education opportunities
Routinely visits 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 properly scope projects, coordinate their execution across functions and develop training and educational programs as required. Manage change control
Participate in the recruitment, evaluation and retention of MDS Staff
Qualification
Required
RN/Therapist or completion of a Bachelor's Degree in a Health Care or related field, consistent with the duties to be performed
Five to Ten years of Clinical Reimbursement or MOS experience
Current knowledge of computer technology and systems
Extensive knowledge of MOS and back-up documentation required and extensive knowledge of state grouper and calculator field relative to MOS and state payment
Extensive knowledge of Medicare reimbursement, RUG IV systems, compliance and edibility
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
Communicate effectively with staff, doctors, and corporate leadership, utilizing diplomacy and discretion
Travel to other facilities required
Company
Topaz Fiscal Services LLC
11-50 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase