MELODIE RHEA
Bellville,OH
Summary
Dedicated Clinical Resource Specialist with Ciena Healthcare, recognized for enhancing MDS accuracy and compliance. Expert in clinical documentation and care coordination, driving quality improvement initiatives. Proven ability to analyze data trends and implement effective training, ensuring timely reimbursements and optimal patient outcomes through meticulous attention to detail and strong organizational skills.
Overview
23
23
years of professional experience
Work History
Clinical Resource Specialist
Ciena Healthcare
03.2023 - Current
- Provide oversight, guidance, and support to facility-level MDS Coordinators and interdisciplinary teams across assigned facilities
- Ensure accurate and timely Minimum Data Set (MDS) assessments, compliance with federal and state regulations, and optimization of reimbursement under the Patient-Driven Payment Model (PDPM).
- Monitor MDS submissions, validation reports, and correction processes to ensure compliance with CMS regulations.
- Conduct regional audits of MDS assessments, care plans, and supporting documentation.
- Provide training and education to facility-level staff on MDS completion, PDPM, ICD-10 coding, and related clinical documentation practices.
- Monitor and analyze regional MDS data for trends in quality indicators, Five-Star ratings, and compliance risk.
- Serve as a resource for new facility MDS Coordinators during onboarding and ongoing development.
- Collaborate with regional and corporate leadership on quality improvement initiatives, clinical documentation standards, and reimbursement strategies.
- Ensure consistent application of corporate policies and procedures related to MDS/RAI processes.
MDS Coordinator
Ciena Healthcare
03.2003 - 03.2023
- Coordinated comprehensive assessments and care plans for residents to ensure compliance with regulatory requirements.
- Set schedules for staff to start and complete MDS assessments and care plan meetings.
- Ensured timely completion of all MDS assessments, maintaining full compliance with federal and state regulations.
- Maintained up-to-date knowledge on CMS guidelines and changes to ensure accuracy in reporting and reimbursement processes.
- Collaborated closely with therapy departments to accurately capture rehabilitation needs within MDS documentation, supporting appropriate resource allocation for residents'' needs.
- Assessed electronic medical record for required documentation to support MDS coding.
- Enhanced patient care quality by implementing comprehensive MDS assessments and care plans.
- Verified prompt and accurate completion of MDS activities for billing.
- Monitored changing regulations related to RAI/MDS requirements, keeping staff informed about updates that impact their daily work routines.
- Developed a comprehensive system for tracking MDS completion deadlines, ensuring timely submissions and minimizing the risk of financial penalties.
- Provided guidance to nursing staff on accurate completion of Section GG assessments, enhancing overall documentation quality and supporting appropriate Medicare/Medicaid reimbursement rates.
- Complied with federal and state regulations for completion and coordination of RAI process.
- Identified areas of improvement in the facility''s quality measures through thorough analysis of MDS data, resulting in targeted interventions and better outcomes for residents.
- Reviewed missing assessment reports and analyzed issues for leadership team.
- Achieved significant improvements in MDS accuracy and timeliness, recognized by facility leadership.
- Streamlined MDS submission process, reducing errors and ensuring timely reimbursements from Medicare and Medicaid.
- Ensured compliance with federal and state regulations by meticulously reviewing and updating resident care plans.
- Advanced personal knowledge of MDS regulations and best practices through continuing education and professional development activities.
Education
Associate of Applied Science - Nursing
Marion Technical College
Marion, OH06-1989
No Degree - Certificate of Practical Nursing
North Central Technical College
Mansfield, OH09-1984
Skills
- Accurate clinical documentation
- Clinical assessment
- Care coordination
- Quality improvement
- Attention to detail
- Effective multitasking
- Reliability
- Effective organizational skills
- Effective task prioritization
- Self motivation
- Time management
Timeline
Clinical Resource Specialist
Ciena Healthcare
03.2023 - Current
MDS Coordinator
Ciena Healthcare
03.2003 - 03.2023
Associate of Applied Science - Nursing
Marion Technical College
No Degree - Certificate of Practical Nursing
North Central Technical College