- Hackensack, New Jersey, United States
- On-site
- Full-time · Associate
- $83K–$120K per year
- 1–3 years
Lead MDS/Clinical Reimbursement Coordinator responsible for MDS and RAI processes, reimbursement strategy, quality measures, interdisciplinary care planning, utilization review, audit readiness, and IDT collaboration.
Compensation
Salary Range: $83,000 to $120,000
Responsibilities
- Direct the timely and accurate completion of the Minimum Data Set (MDS) and Care Area Assessments (CAAs) in strict compliance with CMS regulations.
- Strategically schedule ARDs and audit clinical documentation to capture true resident acuity, optimizing PDPM components, nursing tiers, and NTA scores.
- Analyze Casper reports and partner with the DON/IDT to monitor clinical triggers, drive root-cause corrections, and safeguard the facility's Five-Star rating.
- Oversee the development of individualized resident Care Plans that support MDS coding, establish clear goals, and satisfy all regulatory requirements.
- Lead the weekly Utilization Review (UR) and Triple-Check meetings, collaborating with therapy, nursing, and the business office to validate medical necessity, track managed care authorizations, and ensure accurate billing alignment prior to transmission.