Tara Cares, a long-term care administrative support company, is currently seeking an MDS/Case Mix Consultant to support multiple facilities in the Georgia area.

Position Summary:

Under the direction of the Director of Case Mix Management, the MDS/Case Mix Consultant provides support to facilities to verify that correct and compliant utilization of Medicare and Medicaid services are maintained. Coordinates tracking of Medicare and Medicaid data and educates facility staff on Medicare and Medicaid rules and regulations. Routinely audits to verify facilities are following Federal and State rules and regulations and established policies and procedures.

DUTIES

Demonstrates knowledge, skills, and techniques necessary to care for residents with the following needs: therapeutic, neurological and dementia, dialysis, IV therapy, infectious disease, and wound care, as it applies to clinical reimbursement.
Educates new and current facility staff on established Medicare and Medicaid policies and procedures.
Assists the facilities to implement restorative nursing programs.
Demonstrates knowledge of the Medicare and Medicaid RUG grouper categories, PDPM categories and documentation guidelines.
Demonstrates knowledge of analyzing and tracking the Case-Mix Roster report and making recommendations accordingly.
Develops and periodically updates Medicare and Medicaid policies and procedures as changes occur.
Assists facility with development of Action Plans to correct issues identified through audits.
Is knowledgeable of MDS coding as defined in the RAI Manual. Educates facilities on correct coding and selection of MDS assessments for payment.
Monitors Daily Reconciliation, Team TSI, POD, MLOS reports.
Audits to verify the Medicare non-coverage letters and Physician Certification/re-certifications are complete and sent timely.
Audits a sample of the UB-04's and compares to the medical record to verify the medical record supports the claim.
Monitors ADL documentation for compliance.
Assists the facility with ADR's and Denials.
Monitors the Nursing Restorative Log.
Interacts with the Fiscal Intermediary in areas of coverage and documentation.
Participates in state Medicaid audits and is knowledgeable of state specific regulations.

QUALIFICATIONS

Maintains a current, valid license as an LPN, or RN; BSN preferred.
Possesses a minimum one (1) year of experience in Nursing Service Administration. Additional education or experience in such areas of rehabilitative or geriatric nursing is preferred.
Knowledge of Medicare PDPM preferred.
Must be able to maintain rapport with outside medical professionals.
Must be able to travel with overnight stays required.
Must have MDS experience.
EEO/R/G/V/D

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