Senior Clinical Reimbursement Analyst - RN - Long Term Care

Join to apply for the Senior Clinical Reimbursement Analyst - RN - Long Term Care role at Good Samaritan.

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.

• Provide analytical and reimbursement guidance across all operating segments.
• Review Medicare/Medicaid documentation and assist nursing centers in completing MDS to maximize reimbursement.
• Train and consult on traditional Medicare A and Medicare Advantage coverage, documentation, and eligibility.
• Review MDS documentation for accuracy and appropriateness; audit resident charts to ensure services match needs and documentation reflects case mix/PDPM reimbursement.
• Utilize Care Watch and Point Click Care reports and other tools to verify MDS coding, benchmarks, gaps, and potential reimbursement opportunities.
• Develop work plans with locations to implement practices to maximize reimbursement.
• Partner with Quality to monitor and validate quality measures related to MDS coding.
• Provide direction on ARD to maximize revenues and ensure timely MDS submission per state reimbursement requirements.
• Partner with Compliance to develop and present MDS training materials; assist in training on regulatory changes for Medicare PDPM and Case Mix policies.
• Attend regional meetings, in-service programs, staff meetings, and other center meetings as needed; participate on required committees; assist with hiring of MDS Coordinators.
• Other duties as assigned.

• Bachelor’s degree in nursing or equivalent education is required.
• If degree is in nursing, graduate from a nationally accredited nursing program preferred (CCNE, ACEN, NLN CNEA).
• Minimum of three to five years previous MDS experience preferred; working knowledge of Medicare/Medicaid reimbursement preferred;
  Case Mix and PDPM experience recommended.
• Current unencumbered RN license with the State Board of Nursing where practice occurs; multistate licensure allowed if in a Nurse Licensure Compact state.
• Additional certification from the American Association of Nurse Assessment Coordination (AANAC) may be required within the first six months of employment.
• All certifications and licensures must be maintained; obtain and maintain required department-specific competencies and certifications.

• Facility: Remote WI
• Location: Remote, WI
• 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)

The Good Samaritan…