Revenue Cycle Claims Specialist
Finni Health (YC W23)
Vice President, Clinical Reimbursement
Limitlessli
full-time
Posted on:
Origin: • 🇺🇸 United States • New York
Visit company websiteJob Level
Lead
About the role
- Lead the development, implementation, and continuous improvement of MDS-related reimbursement strategies for long-term care facilities
- Oversee the MDS process, ensuring accurate and timely completion of assessments, coding, and data submission to maximize reimbursement
- Collaborate with clinical and administrative teams to develop strategies that align care delivery with optimal reimbursement opportunities
- Provide leadership and guidance to MDS coordinators, billing, and clinical staff on best practices for MDS documentation and reimbursement
- Analyze reimbursement trends and implement strategies to improve payer mix, case mix index (CMI), and overall revenue capture
- Review and interpret payer policies, regulatory updates, and billing codes to ensure compliance while optimizing financial outcomes
- Drive continuous improvement initiatives to streamline workflows, reduce inefficiencies, and enhance reimbursement accuracy
- Monitor financial performance relative to MDS coding and reimbursement, ensuring adherence to budgetary goals
- Ensure MDS-related processes are compliant with federal and state regulations, including CMS guidelines
- Partner with internal audit and compliance teams to ensure proper documentation and prevent audit or billing disputes
- Serve as liaison between clinical, operational, and financial departments and advise executive leadership on MDS reimbursement trends
- Foster relationships with external payers, auditors, and regulatory agencies to ensure timely and accurate reimbursement
- Lead data analysis and reporting related to MDS, reimbursement performance, and case mix analysis and provide regular reports to senior leadership
- Build and lead a high-performing remote team of MDS professionals through recruitment, training, mentorship, and performance management
Requirements
- Associate Degree in Nursing, Healthcare Administration, Business, or a related field (Bachelor’s degree preferred)
- Minimum of 5 years of progressive experience in healthcare reimbursement, specifically related to MDS in long-term care settings with proven success on CMI and PDPM
- At least 5 years in a senior leadership role with direct responsibility for MDS, reimbursement strategy, or financial management in skilled nursing or long-term care
- In-depth understanding of MDS processes, case mix, and the regulatory environment for long-term care facilities
- Experience with CMS regulations, payer contracting, and reimbursement systems (e.g., PDPM, RUGs, HIPPS codes)
- Strong leadership and management skills, with the ability to influence and collaborate across departments
- Exceptional analytical, financial, and problem-solving skills
- Ability to interpret complex data and translate it into actionable strategies
- Excellent communication skills, both written and verbal, with the ability to present to senior leadership and external stakeholders
- Proficiency with MDS software, Electronic Health Record (EHR) systems, and reimbursement software
- Certification in MDS or related fields (e.g., RNAC, CMAC, or RAC-CT) is preferred but not required
- Essential tools required: reliable computer and noise-canceling headset, a second monitor, stable internet connection and a backup internet connection
