Director, Clinical Reimbursement & PDPM Strategy

Stellar Health Group; Winchester, Northern (MA, KY); Hybrid; USD 150,000 - 210,000; Full time

Benefits offered by this job

Competitive Wages

Shift Differentials

Weekly Pay

6 Paid Holidays

Medical Insurance

Dental Insurance

Vision Insurance

Long-Term Disability Insurance

Short-Term Disability Insurance

PTO Full-Time

401(k)

On-Site Education

Supportive Environment

Job summary

Stellar Health Group is seeking a Director of Clinical Reimbursement – MDS/PDPM to oversee reimbursement, MDS/PDPM accuracy, case-mix management, and compliance across multiple skilled nursing sites.

You will partner with MDS Coordinators, Directors of Rehabilitation, clinical leadership, respiratory teams, facility administrators, and finance to monitor reimbursement performance, strengthen documentation, and support audit readiness.

Qualifications

• Experience in clinical reimbursement, MDS, and PDPM in skilled nursing facilities.
• Strong knowledge of Medicare/Medicaid compliance.
• Ability to coordinate cross-functional teams.

Responsibilities

• Oversee MDS accuracy, PDPM compliance, CMI trends, and case-mix capture across facilities.
• Lead weekly PDPM and CMI review processes, including audit alerts and ARD scheduling.
• Review MDS coding elements for accuracy and oversee Medicare coverage criteria.
• Lead ADR, TPE, and RAC audit responses from record retrieval through submission.
• Coordinate documentation and record requests with facilities and external contractors.
• Maintain audit tracking logs and daily chart recaps.
• Lead onboarding of new facilities and establish standardized reimbursement processes.
• Coordinate MDS and respiratory workflows to ensure accurate reimbursement.

Skills

MDS management

PDPM expertise

Audits & compliance

Job description

Stellar Health Group is seeking a Director of Clinical Reimbursement – MDS/PDPM to oversee reimbursement, MDS/PDPM accuracy, case-mix management, and compliance across multiple skilled nursing sites.

You will partner with MDS Coordinators, Directors of Rehabilitation, clinical leadership, respiratory teams, facility administrators, and finance to monitor reimbursement performance, strengthen documentation, and support audit readiness.