Director, MDS/PDPM Reimbursement & Compliance

Stellar Health Group; Winchester (MA); On-site; USD 120,000 - 170,000; Full time

Benefits offered by this job

Competitive wages

Weekly pay

6 Paid Holidays

Medical insurance

Dental insurance

Vision insurance

Disability insurance

PTO

401(k)

On-site education

Supportive environment

Job summary

Stellar Health Group seeks a Director of Clinical Reimbursement – MDS/PDPM to lead reimbursement governance across a multi-site skilled nursing portfolio. You will ensure accurate documentation, PDPM compliance, and robust audit outcomes while aligning with MDS coordinators, clinical leadership, and finance.

You will drive ADR, TPE, RAC responses, and QC measures, oversee systemic reimbursement processes, and coordinate education, staffing, and performance improvements to support regulatory

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 Section GG, diagnoses, behavioral/SUD add-ons, and MDS coding elements for accuracy.
• Oversee Medicare Part A appeals, beneficiary notices, at-risk cases, and coverage reviews.
• Review LCD and Medicare coverage criteria to support continued stays.
• Maintain PDPM, CMI, and reimbursement tracking tools.

Skills

PDPM Expertise

MDS Knowledge

Audit Management

Cross-functional Leadership

Regulatory Compliance

Tools

PCC

QIES

MMIS

Job description

Stellar Health Group seeks a Director of Clinical Reimbursement – MDS/PDPM to lead reimbursement governance across a multi-site skilled nursing portfolio. You will ensure accurate documentation, PDPM compliance, and robust audit outcomes while aligning with MDS coordinators, clinical leadership, and finance.

You will drive ADR, TPE, RAC responses, and QC measures, oversee systemic reimbursement processes, and coordinate education, staffing, and performance improvements to support regulatory