Director of Clinical Reimbursement
Overview
You will lead enterprise reimbursement operations across Buckner Retirement Services skilled nursing communities. Direct PDPM strategies, MDS processes, and revenue integrity. Collaborate with Finance, Therapy, and Central Billing to reduce denials and optimize performance. Drive transformation and standardization, integrating acquisitions and new systems. Mentor teams and build dashboards, shaping financial sustainability and compliance.
What You'll Do10
- 1Build and lead enterprise PDPM and MDS standards across all skilled nursing communities.
- 2Design audit tools, schedules, and scoring to assess MDS accuracy and reimbursement compliance.
- 3Analyze Case Mix Index and PDPM trends, recommending actions to improve revenue and operations.
- 4Partner with Therapy providers to align documentation and PDPM drivers.
- 5Lead CMS regulatory changes and translate into operational practice.
- 6Develop education programs for revenue integrity and MDS competency.
- 7Collaborate with Finance and Central Billing to resolve claims and optimize payments.
- 8Coordinate with Clinical Operations to improve Section GG documentation.
- 9Implement enterprise dashboards and KPI reporting for reimbursement metrics.
- 10Support acquisition integration and change management initiatives.
Requirements10
- 1RN license and Bachelor's in Nursing, Healthcare Administration, or related field.
- 25+ years in skilled nursing reimbursement, MDS, or PDPM leadership.
- 3RAC-CT certification required, plus AAPACN certification.
- 4Expertise in Medicare reimbursement and MDS processes.
- 5Experience with billing, clinical operations, and therapy partnerships.
- 6Knowledge of CMS, Medicaid, Managed Care, and PDPM regulations.
- 7Skill in auditing, data analysis, and problem-solving.
- 8Proficiency with EMR, MDS systems, and billing platforms.
- 9Ability to drive with valid license and liability insurance.
- 10Age 21 or older to drive for Buckner.
Salary Insight
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