Job Description
Job Title:** Regional (MDS) Reimbursement Consultant (RN)
*Location:** Illinois (Covering Approximately 10 Facilities)
**Salary:** Competitive, based on experience
**We are committed to providing top-tier healthcare services across our network of facilities. We are seeking a highly skilled and experienced Regional (MDS) Reimbursement Consultant to oversee the reimbursement processes for approximately 10 facilities in Illinois. This role is integral to ensuring accurate and maximized reimbursement through both Medicare and Medicaid.
**Job Summary:** The Regional (MDS) Reimbursement Consultant will lead weekly Medicare and Medicaid/CMI meetings at multiple facilities, ensuring compliance with all relevant guidelines and maximizing reimbursement opportunities. This role requires a Registered Nurse (RN) licensed in Illinois with deep expertise in the MDS 3.0, RAI Manual v1.18.11, and the PDPM Medicare and Illinois Medicaid reimbursement methodologies.
**Key Responsibilities:** - **Lead weekly Medicare and Medicaid/CMI meetings** at each facility, providing guidance on reimbursement strategies and ensuring compliance with all regulatory requirements. - Provide expert knowledge on **MDS 3.0, RAI Manual v1.18.11,** including PDPM Medicare and Illinois Medicaid reimbursement methodologies. -
**Assist the Interdisciplinary Team (IDT)** in understanding and implementing strategies to ensure appropriate payment for the reimbursable services provided. - Make recommendations on how to **maximize the facility’s reimbursement** in both Medicare and Medicaid payment systems. - Review and analyze MDS assessments, care plans, and other documentation to ensure accuracy and compliance. - Submit required reports on a weekly basis, ensuring all data is accurate and submitted in a timely manner. - Stay updated on changes in Medicare and Medicaid regulations and reimbursement methodologies, ensuring all facilities are compliant. - Provide training and support to facility staff on MDS and reimbursement processes. - Work closely with facility administrators and directors of nursing to address any issues related to reimbursement and documentation.
**Qualifications:** - **Registered Nurse (RN) license in Illinois** is **required**. - Extensive knowledge of **MDS 3.0, RAI Manual v1.18.11,** PDPM Medicare, and Illinois Medicaid reimbursement methodologies. - Minimum of 3-5 years of experience in a similar role, with a focus on MDS and reimbursement consulting. - Proven ability to lead and facilitate meetings with interdisciplinary teams. - Strong analytical and problem-solving skills. - Excellent communication and interpersonal skills, with the ability to train and support facility staff. - Ability to travel between facilities within Illinois. - High attention to detail and strong organizational skills. - Commitment to ensuring compliance and maximizing reimbursement opportunities.
**Benefits:** - Competitive salary based on experience. - Comprehensive health, dental, and vision insurance.
Equal Opportunity Employer
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