MDS/Clinical Reimbursement Director

The Clinical Reimbursement Director oversees the accurate and timely completion of the Minimum Data Set (MDS) by leading and supporting a team of Clinical Reimbursement Specialists. This role spans multiple facilities and requires deep expertise in MDS processes, the American Association of Nurse Assessment Coordination (AANAC) standards, and quality metrics.    

Summary

•  Maintains and actively promotes effective communication with all individuals. 
• Maintains a positive image of the organization in the community keeping in alignment with our mission, vision, and values. 
• Benchmarking of reimbursement Key Performance Indicators (KPIs). 
• Auditing and report reimbursement strengths and opportunities to key stakeholders, including campus leaders.  
• Drive process improvement initiates based upon identified areas of opportunity. 
• Partner with Clinical Nurse Consultants to promote positive clinical outcomes and margin management to enhance the lives of the individuals we serve.  
• Provide leadership, coaching, development, and training for multiple Clinical Reimbursement Specialists  
• Identify and implement operational processes to meet current and evolving Medicare and Medicaid regulations impacting revenue cycles. 
• Conduct educational in-services as needed, including health center personnel, on regulatory updates and key reimbursement strategies.  
• Maintain proficiency in ICD (International Classification of Diseases) coding and provide relevant training to enhance team capabilities. 
• Manage the denial and appeals process from an enterprise and health center level. 
• Serve as a subject matter in Case Mix Index (CMI), providing ongoing training and support to optimize resident care team awareness.  
• Monitor Quality Measures (QMs) and assess their impact on Centers for Medicare and Medicaid Services (CMS) publicly reported data via Nursing Home Compare.  
• Ensure staff have the tools to efficiently capture and report clinical reimbursement for services rendered.  
• Responsible for on-call services, as assigned. 
• Performs other duties, as assigned. 

• Licensed Registered Nurse (RN) in the state of Wisconsin.  
• Proven experience in Skilled Nursing Facility reimbursement. 
• Demonstrated leadership skills with the ability to mentor and motivate teams. 
• AANAC Resident Assessment Coordinator Certification (RAC-CT) required.
• Commitment to quality outcomes and services for all individuals. 
• Ability to relate well to all individuals. 
• Ability to maintain and protect the confidentiality of information. 
• Ability to exercise independent judgment and make sound decisions. 
• Ability to adapt to change

Benefits

• Health, Dental, & Vision Insurance
• Health Saving Account with Potential Company Contributions
• 401(k) with Company Match
• Financial and Retirement Planning at No Charge
• Paid Time Off and Holidays
• Basic Life Insurance & AD&D - Company Paid
• Short and Long Term Disability - Company Paid
• Voluntary Ancillary Coverage
• Referral Bonuses
• Employee Assistance Program

Illuminus is a faith-based, not-for-profit senior living management company dedicated to serving older adults and families throughout the Midwest with skill and compassion. We own or manage over a dozen communities in Wisconsin and beyond, offering independent senior housing, assisted living and memory care, skilled nursing and rehabilitation, low-income senior housing, home health and hospice services via Commonheart, management support and consulting.

The people of Illuminus are not just our colleagues, our employees, our residents—they are our parents, our grandparents, our partners, ourselves. We serve others with gratitude, dignity, hope and purpose. We believe that the right care can and will transform us all.

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