MDS Solutions - Clinical Reimbursement Specialist
RemoteUnited States
Job Summary
Conduct RAI assessments, develop comprehensive care plans, and deliver targeted education to MDS Coordinators on the Resident Assessment Instrument (RAI) process. Review reimbursement systems for PDPM and Case Mix to ensure accurate and optimized reimbursement while supporting interim long-term and short-term contract coordination. Serve as a trusted advisor to healthcare agencies, offering expert guidance on operations, systems implementation, and technical expertise in interim MDS management. Stay current on federal regulations, QM measures, and the RAI process to ensure compliant, effective solutions. Identify training needs and conduct in-service programs to enhance staff competency. Operate within defined scope of work while maintaining strict adherence to client agreements and HIPAA confidentiality standards.
Required Qualifications
- Bachelor's degree in nursing from an accredited college or university
- at least five (5) years of clinical experience
- 3+ years specializing in the RAI process
- RN License, Current and unrestricted
- active RAC-CT certification
- exceptional critical thinking skills
- proven ability to make informed decisions
- demonstrate sound clinical judgment
- apply expert knowledge in quality improvement concepts and processes
- strong leadership abilities
- excel in interpersonal communication
- foster collaboration
- guide teams to achieve optimal clinical outcomes
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