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Good Samaritan · 14 hours ago

Senior Clinical Reimbursement Analyst - RN - Long Term Care

United States

Full-time

Remote

Mid, Senior Level

$27.50/hr - $44/hr

3+ years exp

Good Samaritan is a not-for-profit organization that has provided over 100 years of housing and services to seniors with a commitment to quality care and service in a Christian environment. This role provides critical analytical and reimbursement related guidance and support to all operating segments across Sanford, focusing on Medicare and Medicaid documentation and training nursing staff on MDS assessment skills.

Health CareNon ProfitRehabilitation

Responsibilities

Provides critical analytical and reimbursement related guidance and support to all operating segments across Sanford

Responsible to review Medicare/Medicaid documentation to assist nursing centers in completing minimum data set (MDS) documentation to assure appropriate levels of Medicare and/or Medicaid reimbursement

Works with executive leadership, administrators, and facility staff in training/consulting on traditional Medicare A / Medicare Advantage coverage, documentation, and eligibility

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

Partners 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

Partners 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 reimbursementMDS experienceCase Mix experiencePDPM experienceAANAC certificationTraining skillsAnalytical skillsCommunication skillsCollaboration skills

Required

Must have Registered Nurse (RN) license

Bachelor's degree in nursing or equivalent education is required

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

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)

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