Timothy Waddell
Cary,NC
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
15
15
years of professional experience
Work History
Regional MDS Director
Southern Healthcare Management
Orlando, Florida
09.2023 - Current
- Oversee 12 facilities in North Carolina and Georgia as the current Regional MDS Director.
- Ensured the highest level of revenue integrity by actively partnering with MDS Coordinators to improve clinical outcomes, compliance protocols, quality reporting accuracy, and correct coding practices.
- Enhanced tracking processes by auditing and analyzing trending data for coding support.
- Reviewed current reporting systems to assess accuracy of facility MDSs and recommended appropriate modifications as needed. Provided comprehensive education to enhance understanding of the reasons for modification requirements.
- Determined skilled level of care for Medicare/Managed Care residents and collaborated with admission teams to ensure appropriate primary diagnoses for new residents, supporting skilled care
- Managed oversight and audit responsibilities for physician certifications, ensuring skilled level of care during Medicare stays
- Achieved improved performance of MDS based Quality Measures as a result of thorough oversight and analysis.
- Educated the facility on CASPER reporting information and its impact on care and quality
- Involved in the recruitment and onboarding of MDS coordinators across multiple sites
- Educated facility team on payment models for PDPM, state-specific Medicaid models, and CMI to ensure compliance with current regulations.
- Adhere to state-specific RAI process regulations
- Provided on-site support to various facility teams by conducting regular visits, subsequently sharing detailed visit reports with both the regional team and Corporate Director of Clinical Reimbursement.
- Responsible for compiling comprehensive monthly reports outlining MDS concerns, staffing-related dilemmas, and average CMI metrics for PDPM and Medicaid in each facility.
- Established strong working relationships with diverse stakeholders such as facility staff, regional/corporate teams, and vendor partners
- Consistently met deadlines while working autonomously and efficiently by employing excellent organizational and time management abilities.
Clinical Reimbursement Specialist
Life Care Centers of America
Cleveland, TN
04.2017 - 08.2023
- Ensured the highest level of revenue integrity by actively partnering with MDS Coordinators to improve clinical outcomes, compliance protocols, quality reporting accuracy, and correct coding practices.
- Enhanced tracking processes by auditing and analyzing trending data for coding support.
- Reviewed current reporting systems to assess accuracy of facility MDSs and recommended appropriate modifications as needed. Provided comprehensive education to enhance understanding of the reasons for modification requirements.
- Determined skilled level of care for Medicare/Managed Care residents and collaborated with admission teams to ensure appropriate primary diagnoses for new residents, supporting skilled care
- Managed oversight and audit responsibilities for physician certifications, ensuring skilled level of care during Medicare stays
- Achieved improved performance of MDS based Quality Measures as a result of thorough oversight and analysis.
- Educated the facility on CASPER reporting information and its impact on care and quality
- Involved in the recruitment and onboarding of MDS coordinators across multiple sites
- Educated facility team on payment models for PDPM, state-specific Medicaid models, and CMI to ensure compliance with current regulations.
- Adhere to state-specific RAI process regulations
- Provided on-site support to various facility teams by conducting regular visits, subsequently sharing detailed visit reports with both the regional team and Corporate Director of Clinical Reimbursement.
- Responsible for compiling comprehensive monthly reports outlining MDS concerns, staffing-related dilemmas, and average CMI metrics for PDPM and Medicaid in each facility.
- Established strong working relationships with diverse stakeholders such as facility staff, regional/corporate teams, and vendor partners
- Consistently met deadlines while working autonomously and efficiently by employing excellent organizational and time management abilities.
MDS Coordinator
Transitional Care Center at Morning View Village
Maryville, TN
04.2015 - 04.2017
- Develop and maintain a weekly resident assessment schedule in accordance with CMS guidelines
- Worked closely with Rehab Manager on the assessment of RUGs scores and reconciliation process.
- Act as Chairperson of the Interdisciplinary Care Plan Team and serves on, participates in, and attends various other committees of the facility (e.g., Nursing Leadership, Quality Improvement Team) as required, and as appointed by the Administrator
- Coordinated interdisciplinary processes and facilitated weekly Utilization Review meetings to evaluate ongoing stay requirements and identify discharge planning obstacles.
- Worked closely with the Education Coordinator to design and present instructional sessions on MDS process documentation to improve staff understanding
- Reviewed patient information and assessed if continued stay is appropriate for commercially insured patients referred to the medical director for recommended discharge.
- Effectively organized and facilitated the Utilization Review process in collaboration with the Interdisciplinary Care Plan Team
- Assigned ICD-10 codes to each resident according to physician and rehabilitation documentation.
MDS Coordinator/RN Supervisor
Kindred Nursing and Rehabilitation Center
Maryville, TN
05.2009 - 04.2015
- Work in collaboration with the Interdisciplinary Team to assess the needs of the resident and the setting of the Assessment Reference Date
- Coordinate and attend Interdisciplinary Team meetings in order to gather information, communicate changes, and maintain and update records and care plans
- Manage the overall process and tracking of all Medicaid/Private pay residents in order to assure appropriate reimbursement for services provided with the center
- Assist with coordination and management of the daily care management meeting, to include review of resident’s current care and possible significant changes in health status
- Complete electronic submission of required documentation to the State database and other entities.
- Coordinated completion of resident assessments in accordance with current federal and state regulations.
- Helped develop comprehensive resident assessment and care plans for 75-bed facility.
- Trained and supervised health care workers conducting resident assessments.
Education
Bachelor of Science in Nursing -
Mountain State University
Beckley, WV05.2004
Licensed Practical Nurse - Nursing
Mercer County Technical Education Center
Princeton, WV08.1998
Nursing Assistant - Nursing
Mercer County Technical Education Center
Princeton, WV12.1996
Skills
- Member of American Association of Post-Acute Care Nursing (AAPACN)
- Credential as a Resident Assessment Coordinator-Certified (RAC-CT) since 2011
- Currently working on credentialing as Resident Assessment Coordinator-Certified Advanced (RAC-CTA)
- 75 years experience as a Divisional MDS specialist overseeing multiple facilities throughout TN, VA, KY, NC, GA, and SC
- Exceptional organizational and time management with outstanding verbal and written communication skills
- Remarkable computer skills in Microsoft Word, Excel, Power Point, and Outlook, and Point Click Care
- Ability to work autonomously and with minimal supervision
- Expert in SNF/LTC Reimbursement, system development and implementation of programs that apply to the Resident Assessment Instrument (RAI), Prospective Payment Systems (PPS), Patient Driven Payment Model (PDPM), Quality Measures (QM’s), Quality Reporting Programs (QRP's), Medicare/Medicaid guidelines, and state specific Medicaid Case Mix
References
References Available Upon Request
Timeline
Regional MDS Director
Southern Healthcare Management
09.2023 - Current
Clinical Reimbursement Specialist
Life Care Centers of America
04.2017 - 08.2023
MDS Coordinator
Transitional Care Center at Morning View Village
04.2015 - 04.2017
MDS Coordinator/RN Supervisor
Kindred Nursing and Rehabilitation Center
05.2009 - 04.2015
Bachelor of Science in Nursing -
Mountain State University
Licensed Practical Nurse - Nursing
Mercer County Technical Education Center
Nursing Assistant - Nursing
Mercer County Technical Education Center
Similar Profiles
Cayla EikelandCayla Eikeland
RN Supervisor at Southern Healthcare ManagementRN Supervisor at Southern Healthcare Management
Jaden JohnsonJaden Johnson
Cook II at Southern Foodservice Management Inc.Cook II at Southern Foodservice Management Inc.
Yasmeen GhaffarYasmeen Ghaffar
Foodservice Manager at Southern Foodservice ManagementFoodservice Manager at Southern Foodservice Management