Skilled Systems Specialist

Salary Rate: $90,000

Establish and maintain partnerships with operations and clinical leadership to support MDS and reimbursement processes.

 Promote effective use of clinical technologies including PointClickCare (PCC) to support documentation accuracy.

Provide end-user support and training related to clinical systems and MDS processes.

Facilitate system training for new implementations and optimization initiatives.

Collaborate with system analysts to develop enhancements that improve workflow and clinical outcomes.

Conduct routine audits of OBRA and PPS (Cert/Recert) assessments to ensure scheduling compliance with CMS regulations.

Perform random audits of completed MDS assessments to validate accuracy, supporting documentation, and reimbursement optimization.

Review Medical Review (MR) packages prior to submission to reduce risk of denials.

Provide support for ADRs, denials, and appeal processes as needed.

Review CMS reports (CASPER, Roster, Admission/Discharge) and reconcile against PCC data to ensure accuracy and identify gaps.

 Monitor CMS QRP Preview Reports to mitigate risk of 2% APU penalty.

Monitor VBP performance indicators including readmissions, infections, and other CMS quality measures.

Review Net Health/PointRight alerts to identify coding inconsistencies, missing data, and QM risks.

Review validation warnings/errors and confirm appropriate corrective action has been taken.

Support onboarding and training of MDS Coordinators and medical records staff.

Provide ongoing education related to CMS regulatory updates and RAI Manual changes.

 Maintain data integrity, security, and HIPAA compliance.

Develop reports and track clinical, regulatory, and reimbursement metrics.

 

 Perform other duties as assigned.