MDS LPN

The McGuire Group Health Care Facilities•Town of Cheektowaga, NY

16h•$66,560 - $68,640•Onsite

About The Position

Garden Gate Health Care Facility is seeking an MDS LPN to support Medicare, Managed Care, and Medicaid reimbursement processes. The role helps ensure accurate MDS completion, regulatory compliance, and reimbursement optimization. The MDS LPN provides reimbursement education and support to facility staff, completes PDPM reviews and MDS assessments, reviews Medicare Part A MDS assessments, and assists with audits, claims, documentation, and coding. The position is full-time, salaried, and scheduled for days. The stated salary is $66,560–$68,640 annually, equivalent to $32–$33 per hour depending on experience. Garden Gate Health Care Facility is part of The McGuire Group and provides skilled nursing, rehabilitation, and long-term care services in New York State. The organization describes its environment as welcoming and focused on compassion, teamwork, and resident-centered care.

Requirements

Graduate of an LPN Vocational Program.
Current unrestricted NYS Licensed Practical Nurse (LPN) license.
At least 2 years of long-term care experience.
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.
Strong communication and interpersonal abilities.
Ability to manage multiple priorities and meet deadlines.
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 facility staff education and support 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.
Monitor reimbursement compliance and establish systems to address areas of non-compliance.
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.
Complete PDPM reviews upon admission, re-admission, or as indicated.
Review Medicare Part A MDS assessments for accuracy and compliance.
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.