Vice President of Reimbursement / Corporate MDS Consultant

Job Title: Vice President of Reimbursement / Corporate MDS Consultant

Department: Corporate Clinical Operations

Reports To: President

FLSA Status: Exempt

Job Type: Full-Time

Location: Corporate Office / Travel Required to LTC and ALF Facilities

Position Summary:

The Vice President of Reimbursement / Corporate MDS Consultant is a key member of the executive leadership team responsible for optimizing clinical reimbursement strategies across all Long-Term Care (LTC) and Assisted Living Facilities (ALFs). This role ensures compliance with federal and state regulations, enhances documentation accuracy, leads training initiatives, and monitors performance related to Minimum Data Set (MDS), Patient-Driven Payment Model (PDPM), and other reimbursement systems. The position serves as a strategic advisor on revenue cycle operations, driving improved financial outcomes and clinical integrity.

Key Responsibilities:

Reimbursement Strategy & Oversight

• Develop and implement enterprise-wide reimbursement strategies aligned with PDPM, Medicaid CMI, and other payer systems.
• Monitor and analyze reimbursement trends and regulatory changes to maximize revenue opportunities and ensure compliance.
• Provide guidance on Medicare, Medicaid, and managed care reimbursement across LTC and ALF settings.
• Lead internal audits of MDS documentation and billing practices to mitigate risk and support accurate claims.
  
  
  

Clinical Documentation & MDS Oversight

• Act as the corporate MDS expert and consultant for facility-based MDS Coordinators and IDT teams.
• Provide education, training, and on-site support to ensure accuracy in MDS assessments and coding practices.
• Develop and implement standardized MDS and care planning procedures.
• Partner with clinical and financial teams to align clinical documentation with reimbursement strategies.
  
  
  

Leadership & Team Development

• Mentor and coach MDS teams, Reimbursement Coordinators, and clinical staff at facility and regional levels.
• Conduct performance evaluations and identify professional development opportunities.
• Coordinate with HR and Operations on recruitment, onboarding, and training of MDS personnel.
  
  
  

Compliance & Quality Assurance

• Ensure company-wide compliance with CMS regulations and survey readiness related to MDS and billing.
• Collaborate with Quality Assurance teams to integrate MDS data into QAPI initiatives.
• Monitor risk areas related to RUGs, PDPM, and case mix to proactively address deficiencies.
  
  
  

Collaboration & Reporting

• Serve as a liaison between operations, clinical services, billing, and finance departments.
• Prepare executive-level reports and presentations on reimbursement performance and regulatory impacts.
• Participate in strategic planning, budgeting, and forecasting related to reimbursement.
  
  
  

Qualifications:

• Licensed Registered Nurse (RN) required; BSN or higher preferred.
• RAC-CT certification required; RAC-CTA preferred.
• Minimum of 8 years of MDS and reimbursement experience in LTC/ALF settings, with at least 5 years in a leadership or corporate consultant role.
• Deep knowledge of Medicare/Medicaid reimbursement systems, PDPM, MDS 3.0, RAI manual, and CMI calculations.
• Proven ability to lead audits, drive process improvement, and develop clinical teams.
• Strong analytical, interpersonal, and communication skills.
• Willingness to travel to facilities across the organization as needed (up to 50%).
  
  
  

Working Conditions:

• Hybrid position with a mix of corporate office, remote work, and on-site facility visits.
• May require extended hours during survey periods or fiscal year-end activities.