MDS Lead RN

The McGuire Group•Williamsville, NY

7d•Onsite

About The Position

Harris Hill Nursing Facility is looking to add an MDS Lead RN to its team. In this role, you’ll coordinate Medicare, Managed Care, and Medicaid reimbursement activities while ensuring accurate MDS completion, regulatory compliance, and reimbursement optimization. You’ll also provide education and support to facility staff while overseeing MDS processes and assisting with reimbursement-related audits and reviews. If you have experience with MDS, PDPM, and long-term care reimbursement, this could be the perfect opportunity for you. Located in the heart of Williamsville, Harris Hill Nursing Facility is proud to be part of The McGuire Group, a leader in skilled nursing and rehabilitation services throughout New York State. As a CMS 5-Star rated facility, Harris Hill is recognized for its commitment to quality care and clinical excellence. Our team is known for its collaborative culture, strong resident relationships, and dedication to helping both residents and employees thrive.

Requirements

Associate's Degree in Nursing
2 years of long-term care experience
Current unrestricted NYS Registered Nurse (RN) License required
Experience with MDS, PDPM, reimbursement, and quality measures
Strong understanding of Medicare, Medicaid, Managed Care, and third-party payer requirements
Excellent time management, organizational, and problem-solving skills
Proven leadership skills with the ability to mentor and support team members
Strong communication and interpersonal abilities
Ability to manage multiple priorities and meet deadlines
In-depth knowledge of long-term care regulations, reimbursement methodologies, and standards of care
Ability to provide education, training, and support to interdisciplinary teams

Nice To Haves

Bachelor's Degree in Nursing preferred
4 years of long-term care experience preferred

Responsibilities

Provide education and support to facility staff regarding Medicare, Medicaid, Managed Care, eligibility, certification, coverage, documentation, utilization, and reimbursement
Assist facilities with certification procedures, reimbursement-related processes, and resolution of problem areas
Collaborate with claims review units, compliance teams, and third-party payers to ensure regulatory and company compliance
Assist with the review and preparation of denied claims, audits, and administrative record reviews
Assess compliance with Medicare, Medicaid, Managed Care, and third-party payer requirements and develop corrective action plans as needed
Maintain and analyze reimbursement-related statistical data and utilization trends
Monitor authorizations and compliance with third-party payer requirements
Provide ongoing education and training related to reimbursement programs and regulatory changes
Conduct PDPM reviews upon admission, re-admission, or as indicated
Review Medicare Part A MDS assessments for accuracy and compliance
Supervise MDS LPN activities and co-sign MDS assessments completed by LPN staff as required
Gather documentation for CMS audits and other reimbursement-related audits
Review physician documentation and assist with accurate ICD-10 coding and diagnosis ranking
Conduct MDS integrity reviews and complete MDS assessments as needed
Perform additional duties as assigned