Registered Nurse (RN) – MDS Coordinator to support resident assessments, care planning, reimbursement processes, and quality outcomes through interdisciplinary collaboration.
Responsibilities
Coordinate and complete MDS assessments in accordance with federal and state regulations
Ensure accurate, timely, and compliant clinical documentation
Collaborate with interdisciplinary team members on resident assessments and care planning
Monitor quality measures, clinical outcomes, and reimbursement opportunities
Review clinical records to ensure documentation supports resident care and reimbursement requirements
The Network Services Associate will handle data entry, analyze data sets, handle incoming Provider bill status emails, and process reconsiderations, disputes, and state disputes.
Locations (2)
Tampa, Florida, United States
United States
Responsibilities
Respond to email bill inquiries and disputes from providers, clients and internal customers.
Work with Finance, Provider Management, and external network partners to resolve provider disputes and questions.
Work with clients to resolve pricing issues and state disputes within regulatory timeframes.
Treat all customers, internal and external, in a courteous and cooperative manner by providing exceptional customer service to internal and external customers
Understand and comply with all HIPAA & SOC2 requirements necessary in working with designated PHI
Provide education and support to facility staff regarding Medicare, Medicaid, Managed Care, eligibility, certification, coverage, documentation, utilization, and reimbursement while overseeing MDS processes and assisting with reimbursement-related audits and reviews.
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
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.
The Future Leaders MDS Coordinator in Training (MDS-IT) plays a critical role in developing the next generation of clinical reimbursement leaders within Genesis skilled nursing facilities.
Compensation
USD $42.00 - USD $43.00 /Hr.
Responsibilities
Develop competencies required to manage the Minimum Data Set (MDS) process
Lead clinical reimbursement strategy for skilled nursing facilities, translating national reimbursement expertise into product features and ensuring compliance.
Compensation
Competitive salary, equity and benefits.
Responsibilities
Translate RAI and MDS expertise into product
Serve as subject‑matter expert on RAI Manual, MDS 3.0, PDPM, Section GG, Care Area Assessments and Quality Measures
Map platform observations to MDS items, look‑back periods and PDPM components
Define clinical and reimbursement requirements with product, data science and engineering
Monitor CMS rule changes and state Medicaid case‑mix methodologies
Requirements
RN license (or LPN/LVN with equivalent senior experience)
RAC-CT, RAC-CTA or equivalent AAPACN certification
Nice to have: product or engineering collaboration
Nice to have: AI or analytics validation
Nice to have: consulting or health‑tech vendor experience
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