Clinical Reimbursement Consultant (Regional MDS)
at Facility Support Company

Date Posted: 12/1/2019

Job Description

The Clinical Reimbursement Consultant is responsible for assisting facilities within their assigned area to obtain appropriate revenue within Medicare and Medicaid guidelines.


 Accuracy of MDS assessments and maintain all Resident Assessment Instrument (RAI) guidelines, time frames and procedures.

 Educate regional and facility teams in case management related to managed care, PPS and Case Mix programs and keep facilities updated with new regulations.

 Train team members how to strategize and optimize appropriate revenue.

 Be knowledgeable regarding Medicare issues impacting revenue such as distribution, LOS, ADL accuracy and compliance, census, planned and unplanned discharges for assigned facilities.

 Review month end reports and data identifying strengths and opportunities to improve appropriate revenue.

 Chart audits completed during facility visits for both OBRA and PPS assessments; focusing on accuracy of codes per RAI definitions, ARD selection, extensive qualifier identification, therapy minute management, ADL compliance, timely completion, and adherence to company policies regarding transmission, month end close, scheduling of assessments, etc.

 Train new MDS personnel on MDS data entry and submission software, company policies and expectations for their role as Clinical Reimbursement Directors and/or Specialists.

 Responsible for evaluating and providing education, intervention and support for Medicare, PPS, RAI, state specific and special contact reimbursement.

 Attend Regional Team Meetings and other meetings as assigned.

 Field calls regarding coding, skilling, etc.

 Trip reports at all facilities on a timely basis.

 Provides support for facility to assist them in determining appropriate coverage, complete documentation, accurate assessment, timely transmissions, and maximum utilization.

 Manage and direct Clinical Reimbursement Directors and CRSs’ in a “Matrix Management” environment.

 Oversee accurate and complete the process for Medicare/Medicaid denial process.

 Other duties as assigned

Job Requirements


 Knowledge and understanding of regulatory processes (Federal, and/or State Regulations)

 Knowledge of the RAI Regulations

 Knowledge of principles and processes for providing customer service. This includes

customer needs assessment, meeting quality standards for services, and evaluation of

customer satisfaction.

Patient Driven Payment Model (PDPM)


 Effective verbal and written communication skills

 Understanding written sentences and paragraphs in work related documents.

 Actively looking for ways to help people.

 Communicating effectively in writing as appropriate for the needs of the audience.


 Ability to work in a “Matrix” management environment

 The ability to listen to and understand information and ideas presented through spoken

words and sentences.

 Ability to relate positively, effectively, and appropriately with residents, families,

community members, volunteers, and other facility staff. Possess special interest in

working with long-term care residents and the elderly.


 Computer literacy skills (Microsoft Outlook, Microsoft Office, Internet)

 High School Diploma required.

 One to three years of professional experience and/or training; or equivalent combination

of education and experience.


 Licensed RN

 Licensed or eligible for licensure by the state in which you provide consultative services

 CPR certification

We are an Equal Opportunity Employer and Drug Free Work Place

Job Snapshot

  • Employee Type: Full-Time
  • Location: Orlando, FL
  • Job Type: Nurse
  • Experience: Not Specified
  • Date Posted: 12/1/2019

About Us

Facility Support Company is a progressive leader in providing a full range of consulting services Nationwide.

Facility Support Company’s goal is to keep pace with the challenges that are reshaping America’s healthcare future and to take an active role in adapting alternatives to meet those challenges.

The Facility Support Company’s team consists of experienced professionals with over 250 years of combined expertise in the management of healthcare operations.

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