Sr Clinical Reimbursement Analyst - Sanford Health
City - Remote SD, SD
About the Job
Careers With Purpose
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.
Facility: Remote SD (Central Time)
Location: City - Remote SD, SD
Address:
Shift: 8 Hours - Day Shifts
Job Schedule: Full time
Weekly Hours: 40.00
Department Details
Flexible, fun team that works together to improve assessment skills to capture accurate levels of care provided while ensuring reimbursement levels are achieved.
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 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. Case Mix and PDPM experience recommended.
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.
Benefits
Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits .
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .
Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Req Number: R-0203547
Job Function: Finance
Featured: No
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.
Facility: Remote SD (Central Time)
Location: City - Remote SD, SD
Address:
Shift: 8 Hours - Day Shifts
Job Schedule: Full time
Weekly Hours: 40.00
Department Details
Flexible, fun team that works together to improve assessment skills to capture accurate levels of care provided while ensuring reimbursement levels are achieved.
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 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. Case Mix and PDPM experience recommended.
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.
Benefits
Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits .
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .
Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Req Number: R-0203547
Job Function: Finance
Featured: No
Source : Sanford Health
