Senior Clinical Reimbursement Analyst - RN - Long Term Care

Good Samaritan Society

5d•$28 - $44

About The Position

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. This role 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.

Requirements

Bachelor's degree in nursing or equivalent education is required. If degree is in nursing, 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.
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.

Nice To Haves

Case Mix and PDPM experience recommended.
Preference to reside in the state of IA. May live in a surrounding state (SD, NE, MN, WI, etc...)

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.