Clinical Reimbursement Coordinator, RN

Sandia Ridge Center; Albuquerque (NM); On-site; USD 92,000 - 104,000; Full time

Benefits offered by this job

Variable compensation plans

Tuition discounts

Employee Assistance Program

Health, dental, vision

401K

Paid Time Off

Life insurance

Job summary

Sandia Ridge Center is seeking an experienced MDS Nurse -- RN to manage Medicare/Medicaid case-mix documentation and ensure accurate reimbursement for services provided within the nursing facility.

The role requires an RN license in the applicable state, at least one year of long-term care nursing experience, and knowledge of MDS, case-mix, and billing processes. BLS/CPR certification is required, with opportunities for professional growth.

Qualifications

• Must be a graduate of an accredited School of Nursing with current RN licensure in the state of employment.
• One year of long term care clinical nursing experience is required.
• Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and/or case management is highly desirable.
• Must maintain current BLS/CPR certification (excluding ALFs/ILFs).

Responsibilities

• MDS Nurse -- RN manages the overall process and tracking of all Medicare/Medicaid case-mix documents to ensure appropriate reimbursement.
• Maintain an accurate schedule of all MDS assessments and ensure timely submission including OBRA and OSRA requirements.
• Perform concurrent MDS review to ensure correct RUGs category through appropriate clinical information capture.
• Communicate case-mix data for billing (RUGs, modifiers, state case-mix scores) to Business Office.
• Serve as nursing center resource for MDS/RUGs and state case-mix systems with staff education and instruction on MDS terminology.

Skills

RN licensure

Long term care experience

Medicare/Medicaid reimbursement

MDS completion

Case management

BLS/CPR certification

Education

Graduate of accredited School of Nursing

Job description

Overview: We are dedicated to improving the lives we touch through the delivery of high-quality care and exceptional service. As a leading provider in the long-term care industry, we believe in fostering a collaborative, inclusive and supportive work environment where every team member is valued and empowered to make a difference. Whether you're an experienced professional or just starting your career, we offer opportunities for growth, development, and advancement in a range of roles. Join us in our mission to enhance the well-being of our patients and residents while making a meaningful impact in the communities we serve.

Responsibilities

• MDS Nurse -- RN manages the overall process and tracking of all Medicare/Medicaid case-mix documents to ensure appropriate reimbursement for all services provided within the nursing.


• Maintain an accurate schedule of all MDS assessments to include the proper reference dates throughout the patient stay and ensures the accurate and timely submission of the MDS assessments including case-mix, OBRA and OSRA required assessments.


• Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture of appropriate clinical information and in this process identify opportunities to enhance reimbursement.


• Communicate case-mix data required for billing to the Business Office such as RUGs categories, modifiers, state case-mix scores, etc.


• Serve as the nursing center resource for MDS/RUGs and state case-mix systems providing staff case-mix education and instruction on MDS terminology and format.

Qualifications

• Must be a graduate of an accredited School of Nursing with current RN licensure in the state in which employment occurs is required.


• One year of long term care clinical nursing experience is required.


• Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and/or case management is highly desirable.


• Must maintain current BLS/CPR certification (excluding ALFs/ILFs).

Benefits

• Variable compensation plans


• Tuition, Travel, and Wireless Service Discounts


• Employee Assistance Program to support mental health


• Employee Foundation to financially assist through unforeseen hardships


• Health, Dental, Vision, Company-paid life insurance, 401K, Paid Time Off


• Free 24/7virtual health careprovided by licensed doctorsforall Anthemmedically-enrolled employees and theirimmediate family members


• On-Demand Pay Program that allows for instant access to a portion of the money you’ve already earned


• We also offer several voluntary insurances such as:
  
  
  • Pet Insurance
  
  
  • Term and Whole Life Insurance
  
  
  • Short-term Disability
  
  
  • Hospital Indemnity
  
  
  • Personal Accident
  
  
  • Critical Illness
  
  
  • Cancer Coverage
  
  
  
  

Restrictions apply based on collective bargaining agreements, applicable state law and factors such as pay classification, job grade, location, and length of service.

Posted Salary Range: USD $91,520.00 - USD $104,000.00 /Yr.