Senior Clinical Reimbursement Analyst – RN, Long Term Care
Sanford Health
full-time
Posted on:
Location Type: Remote
Location: Iowa • Montana • United States
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Salary
💰 $28 - $44 per hour
Job Level
About the role
- Reviews MDS documentation for accuracy and appropriateness.
- Audits resident's chart to monitor that services match needs and documentation reflects categories for case mix/PDPM reimbursement.
- Utilizes Care Watch and Point Click Care reports and any other available tools/reports for accuracy of MDS coding, benchmarks, gaps and potential related reimbursement opportunities.
- Develops work plans with locations to implement appropriate practices/processes to maximize reimbursement.
- Partner with Quality team to monitor and validate quality measures report for accuracy of MDS coding.
- Provides direction on Assessment Reference Date (ARD) process for assigned centers to ensure we are setting the ARD to maximize revenues and submit MDS timely, as applicable to State reimbursement and payer.
- Partners with and assists Compliance with developing and presenting training materials for MDS training sessions.
- Assures that facilities follow Medicare/Medicaid regulatory guidelines related to reimbursement and MDS submission requirements.
- Participates in hiring of MDS Coordinators at location level in partnership with facility operations.
- Assists nursing staff in improving MDS assessment skills through formal and informal training.
- Coordinates training and communication with Clinical Services staff as needed.
- Subject matter expert resource for field operations of regulatory change for Medicare/Medicaid reimbursement and communicates necessary information to appropriate personnel in field and operations.
- Partner with Compliance and other stakeholders in developing and updating Medicare PDPM and Case Mix policies and procedures.
- Attends and participates as needed in regional meetings, scheduled in-service programs, staff meetings and other center meetings and sits on required committees.
- Other work duties as assigned.
Requirements
- Bachelor’s degree in nursing or equivalent education is required.
- Minimum of three to five years previous MDS experience preferred.
- Working knowledge specifically in Medicare and Medicaid reimbursement is preferred.
- Case Mix and PDPM experience recommended.
- Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state.
- Additional certification from the American Association of Nurse Assessment Coordination (AANAC) may be required within the first six months of employment from date of hire.
- All certification and licensures must be maintained.
- Obtains and subsequently maintains required department specific competencies and certifications.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
MDS documentationMDS codingMedicare reimbursementMedicaid reimbursementCase MixPDPMassessment skillstraining developmentregulatory compliancedata analysis
Soft skills
communicationcollaborationleadershiptrainingdirectionmonitoringauditingproblem-solvingorganizationalinterpersonal
Certifications
RN licenseAANAC certificationmultistate licensuredepartment specific competencies