Sanford Health is hiring a Senior Clinical Reimbursement Analyst - RN to provide critical analytical and reimbursement guidance across our Long Term Care operating segments. In this key role, you will ensure appropriate MDS completion and reimbursement levels by reviewing Medicare and Medicaid documentation, while partnering with leadership and facility staff on coverage, documentation, and eligibility.
What You'll Do
- Review Medicare and Medicaid documentation to assist nursing centers in completing Minimum Data Set (MDS) documentation.
- Work with executive leadership, administrators, and facility staff on training and consulting for 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 categories for case mix and PDPM reimbursement.
- Utilize Care Watch and Point Click Care reports and other tools for accuracy of MDS coding, benchmarks, gaps, and reimbursement opportunities.
- Develop work plans with locations to implement practices and processes that maximize reimbursement.
- Partner with the Quality team to monitor and validate the quality measures report for accuracy of MDS coding.
- Provide direction on the Assessment Reference Date (ARD) process to maximize revenues and submit MDS timely.
- Partner with Compliance to develop and present training materials for MDS training sessions.
- Assure facilities follow Medicare and Medicaid regulatory guidelines related to reimbursement and MDS submission.
- Participate in hiring MDS Coordinators at the location level.
- Assist nursing staff in improving MDS assessment skills through formal and informal training.
- Coordinate training and communication with Clinical Services staff as needed.
- Act as a subject matter expert resource for field operations on regulatory changes for Medicare and Medicaid reimbursement.
- Partner with Compliance and stakeholders to develop and update Medicare PDPM and Case Mix policies and procedures.
- Attend and participate in regional meetings, in-service programs, staff meetings, and required committees.
What We're Looking For
- Bachelor’s degree in nursing or equivalent education.
- Currently holds an unencumbered RN license with the State Board of Nursing where practice occurs and/or possess multistate licensure if in an NLC state.
- Must be a Registered Nurse (RN) in the state of Minnesota.
- All certification and licensures must be maintained.
- Obtains and subsequently maintains required department specific competencies and certifications.
Nice to Have
- Graduate from a nationally accredited nursing program (e.g., CCNE, ACEN, NLN CNEA).
- Minimum of three to five years previous MDS experience.
- Working knowledge specifically in Medicare and Medicaid reimbursement.
- Case Mix and PDPM experience.
- Additional certification from the American Association of Nurse Assessment Coordination (AANAC) may be required within the first six months.
Technical Stack
- Care Watch
- Point Click Care
Team & Environment
You will partner with the Quality team, Compliance, Clinical Services staff, and field operations to drive accurate reimbursement and regulatory adherence.
Benefits & Compensation
- Compensation: $27.50 - $44.00 per hour.
- Proud to offer many development and advancement opportunities.
Work Mode
This is a remote position open to candidates in Minnesota, North Dakota, South Dakota, Iowa, and Wisconsin.
Sanford is an EEO/AA Employer M/F/Disability/Vet.
