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About the Role
Coordinate Medicare, Managed Care, and Medicaid reimbursement activities, ensuring accurate MDS completion, regulatory compliance, and reimbursement optimization. Provide education and support to facility staff, oversee MDS processes, and assist with reimbursement-related audits and reviews.
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
- Associate's Degree in Nursing required; Bachelor's Degree in Nursing preferred
- 2 years of long-term care experience required; 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
- Proven 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
- Ability to provide education, training, and support to interdisciplinary teams
Skills
- MDS
- PDPM
- Long-term care reimbursement
- Medicare
- Managed Care
- Medicaid
- Third-party payer requirements
- Time management
- Organizational skills
- Problem-solving skills
- Leadership skills
- Communication skills
- Interpersonal skills
- ICD-10 coding
Location
- Cheektowaga, NY
Work Type
- Full-Time
Experience Level
- 2 years of long-term care experience
- 4 years of long-term care experience preferred
Education Level
- Associate's Degree in Nursing
- Bachelor's Degree in Nursing preferred
Salary/Compensations
- $74,880 - $76,960
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
About the Company
- Garden Gate Health Care Facility is part of The McGuire Group, a recognized leader in skilled nursing, rehabilitation, and long-term care services throughout New York State.
- Our team is dedicated to creating a welcoming environment where residents, families, and employees feel valued and supported.
- With a strong focus on compassion, teamwork, and resident-centered care, Garden Gate offers a rewarding opportunity to grow your career while making a meaningful difference in the lives of others every day.