MDS Lead RN

Responsibilities

• Provide education and support to 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 the review and preparation of denied claims, audits, and administrative record reviews
• Assess compliance with Medicare, Medicaid, Managed Care, and third-party payer requirements and develop corrective action plans as needed
• 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
• Conduct PDPM reviews upon admission, re-admission, or as indicated
• Review Medicare Part A MDS assessments for accuracy and compliance
• Supervise MDS LPN activities and co-sign MDS assessments completed by LPN staff as required
• 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

Requirements

• Minimum education requirement: Associate's Degree in Nursing; Bachelor's Degree in Nursing preferred
• Minimum experience requirement: 2 years of long-term care experience; 4 years of long-term care experience preferred
• Current unrestricted NYS Registered Nurse (RN) License required
• 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
• Prominent leadership skills with the ability to mentor and support team members
• Strong communication and interpersonal abilities
• Ability to manage multiple priorities and meet deadlines
• In-depth knowledge of long-term care regulations, reimbursement methodologies, and standards of care

Benefits

• Paid Time Off (PTO) for Full-Time and Part-Time
• Weekly or Same-Day Pay Options
• Health, Dental, and Vision Insurance
• Life Insurance
• Employee Referral Bonus Program