Senior Clinical Reimbursement Consultant (RN)

About the role

The Senior Clinical Reimbursement Consultant (RN) will serve as a trusted advisor to executive leadership of skilled nursing facilities, optimizing Medicare Part A PDPM reimbursement, Pennsylvania Medicaid Case Mix, MDS coding accuracy, and clinical documentation.

Key responsibilities

• Provide strategic guidance on Medicare PDPM, Medicaid CMI, and documentation improvement to improve financial performance.
• Conduct on‑site resident observations and validate MDS Section GG coding across ADLs, mobility, cognition, and other clinical domains.
• Perform root‑cause analyses of reimbursement barriers and develop sustainable operational solutions.
• Audit ICD‑10‑CM coding, clinical category assignments, and interdisciplinary documentation for compliance.
• Mentor MDS coordinators, nursing directors, therapy teams and deliver education on reimbursement regulations.

Required profile

• Current RN license in good standing.
• 3–5 years of progressive clinical reimbursement experience, including Medicare Part A PDPM and Pennsylvania Medicaid CMI.
• Proven ability to travel regularly to multiple facilities and influence executive‑level stakeholders.

Required skills

• Medicare Part A PDPM reimbursement expertise.
• Pennsylvania Medicaid Case Mix (CMI) knowledge.
• MDS 3.0 coding and validation.
• ICD‑10‑CM coding.
• Clinical Documentation Improvement (CDI) techniques.
• Resident observation and clinical assessment skills.
• Familiarity with PointClickCare, IntelliLogix or comparable EMR systems.