Medicaid – MDS Compliance Partner at Ensign Services

Ensign Services, Inc.’s (ESI) Compliance Department is seeking a License Vocational Nurse or Registered Nurse Compliance Partner. Must have at least five years’ nursing and Minimum Data Set (MDS) experience in the Skilled Nursing/Long Term Care environment. Primary responsibilities will involve performing Medicare/Medicaid billing audits and conducting internal investigations under the direction of the associate and chief compliance officer, reviewing, and analyzing medical records and/or claims to detect possible compliance or quality issues.

Our compliance philosophy is to work closely with field facilities, agencies, and resources to develop solid relationships that enhance and foster compliance throughout the organization. We provide training, oversight, and auditing functions, and serve as partners to our providers to assist them in building successful businesses in an ethical and compliant manner.

Duties

• Creates and presents regular training on Medicare/Medicaid claim management, clinical compliance, and general healthcare compliance topics.
• Performs Medicare/Medicaid claim review portion of internal compliance audits.
• Analyzes claims data and medical records to detect possible compliance or quality issues and assists operations in developing a corrective action plan to resolve them.
• Conducts internal investigations involving general compliance and clinical issues under the direction of a lead compliance partner or the chief compliance officer.
• Provides advice and instruction on claim denial management and appeals.
• Travel required 70% of the time within Utah, Texas, Nevada, and other states.

Experience/Qualifications

• Must be a Licensed Vocational Nurse or Registered Nurse.
• A minimum of five years’ experience in a Skilled Nursing Facility/Long Term Care.
• Extensive experience in Medicare/Medicaid MDS.
• Understanding of the legal and regulatory framework governing the skilled nursing industry.
• Ability to work with all levels of management on potentially complex compliance/regulatory issues.

Desired Skills

• Superior interpersonal communication skills.
• Strong writing skills required to write and edit policies and procedures, compliance reports, and other communications.
• Works well independently in a home office environment on long-term projects and as a member of an interdisciplinary team.
• An engaging and informative teacher for regular training of facility personnel regarding Medicare requirements.
• Possesses and conveys a high degree of credibility and integrity.
• A desire to constantly improve Medicare/Medicaid management systems and organizational compliance.
• Understands and accepts the unpredictable nature and needs of the compliance function in a large organization.
• Exhibits analytical skills and an understanding of operational processes.

Additional Information

• Salary: Commensurate with experience.
• Number of Positions Available: 1.
• Position Type: Full Time, Employee.
• Benefits: Medical/Dental/Vision coverage, company-provided life insurance, 401(k) with company match, and sick/vacation plans.
• Schedule: Typically business hours but may vary depending on workload and travel needs - 40 hrs/week.
• Location: Based out of home office and regularly travels to assigned facilities; must reside near a major airport in the following area: