Senior Clinical Reimbursement Analyst - RN - Long Term Care
Listed on 2026-09-22
-
Healthcare
Healthcare Administration, Healthcare Management
- Long Term Care
Join to apply for the Senior Clinical Reimbursement Analyst - RN
- Long Term Care role at Good Samaritan
- Long Term Care
3 days ago Be among the first 25 applicants
Join to apply for the Senior Clinical Reimbursement Analyst - RN
- Long Term Care role at Good Samaritan
Careers With Purpose
Join our 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.
Careers With Purpose
Join our 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.
Facility: Remote SD (Central Time)
Location: Remote, SD
Address
Shift: 8 Hours - Day Shifts
Job Schedule: Full time
Weekly Hours: 40.00
Salary Range: $27.50 - $44.00
Department Details
Remote position located in Minnesota. May live in a surrounding state (ND, SD, IA or WI)
Must be a Registered Nurse (RN) in the state of Minnesota
Job Summary
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.
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.
Qualifications
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…
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