Clinical Reimbursement Coordinator, RN

MDS Nurse - RN

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

The 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 24/7 virtual health care provided by licensed doctors for all Anthem medically-enrolled employees and their immediate 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.