Mds LPN

The McGuire Group•Cheektowaga, NY

12d•Onsite

About The Position

Garden Gate Health Care Facility is hiring a full-time, salaried MDS LPN in Cheektowaga, New York. The position supports Medicare, Managed Care, and Medicaid reimbursement processes and helps ensure accurate MDS completion, regulatory compliance, and reimbursement optimization. The role works with facility staff, claims review units, compliance teams, and third-party payers, and provides education and support regarding reimbursement programs and regulatory requirements.

Requirements

Graduate of an LPN vocational program.
At least 2 years of long-term care experience.
Current unrestricted New York State Licensed Practical Nurse (LPN) license.
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.
4 years of long-term care experience.

Responsibilities

Educate and support 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 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.