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Sanford Health · 1 day ago

Senior Clinical Reimbursement Analyst - RN - Long Term Care

United States

Full-time

Remote

Senior Level

$27.50/hr - $44/hr

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. This role provides critical analytical and reimbursement related guidance and support to all operating segments across Sanford, focusing on reviewing Medicare/Medicaid documentation to assist nursing centers in maximizing reimbursement.

ChildrenEducationHealth Care

H1B Sponsor Likely

Responsibilities

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

Qualification

Registered Nurse (RN) licenseMedicare/Medicaid knowledgeMDS documentationCare Watch proficiencyPoint Click Care proficiencyTraining skillsAnalytical skillsCommunication skills

Required

Must have Registered Nurse (RN) license

Bachelor's degree in nursing or equivalent education is required

Preferred

Graduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA)

Company

Sanford Health

Glassdoor3.5

Sanford is a healthcare company providing research, education and clinical care.

Founded in 1894

Sioux Falls, South Dakota, USA

10001+ employees

http://www.sanfordhealth.org

H1B Sponsorship

Sanford Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (26)

2024 (37)

2023 (38)

2022 (51)

2021 (64)

2020 (30)