Clinical Reimbursement Consultant

Responsibilities

• Assist the client with assessing, planning, developing, and implementing systems, processes, and other needs as requested.
• Aid the client with clinical reimbursement systems and training.
• Train for MDS 3.0 Basics course, CAAs, care planning, PDPM, and Quality Measures.
• Maintain current working knowledge of applicable state and federal standards, regulations, and industry standards of practice.
• Identify training needs; plan and conduct training/in-services as requested.
• Support clients as requested in the selection and hiring of key management staff.
• Participate in/conduct comprehensive quality assessments as requested.
• Maintain client confidentiality and function within HIPAA regulations.
• Travel throughout the state or states licensed in.

Qualifications

• RN license.
• RAC-CT is required, RAC-CTA preferred.
• Comprehensive knowledge of the full clinical reimbursement process within skilled nursing and long-term care settings.
• Extensive understanding of Medicare, Medicaid, Managed Care, and other payer reimbursement methodologies.
• Strong working knowledge of MDS assessment processes, reimbursement systems, case mix management, and reimbursement optimization strategies.
• Experience with Patient-Driven Payment Model (PDPM), Case Mix Groups (CMGs), and Care Area Assessments (CAAs).
• Ability to interpret and apply federal and state reimbursement regulations while ensuring compliance and maximizing reimbursement opportunities.
• Proficiency in reviewing clinical documentation to support accurate coding, assessment completion, and reimbursement outcomes.

Special Position Requirements

• Must maintain all required professional licenses and certifications if applicable.
• Provide proof of current and in good standing licensure if applicable.
• Must maintain an active driver’s license and provide proof of auto insurance upon request.

What We Offer

• 401(k) Retirement Plan – Plan for your future with company-supported contributions.
• Paid Time Off – Vacation and sick leave to recharge and handle personal matters.
• Medical Premium Reimbursement – Support for health insurance costs.
• Dental Coverage – Optional dental plans to keep your smile healthy.
• Ancillary Benefits – Additional products and perks, such as vision coverage, life insurance, and wellness programs.