Regional MDS & Reimbursement Specialist

OPCO Skilled Management; Albuquerque (NM); On-site; USD 90,000 - 110,000; Full time

Benefits offered by this job

Paid-Time Off

Job summary

OPCO Skilled Management is seeking a Regional Reimbursement Coordinator to lead MDS services across multiple facilities. You will support clinical leadership, train staff on PDPM, PASSAR, and regulatory requirements, and ensure accurate resident assessments and billing alignment.

The role emphasizes training, compliance, and metric development to improve quality of care and financial performance. You will supervise MDS Coordinators, collaborate with the Compliance Team, and maintain adherence to

Qualifications

• Currently licensed as RN in the state practiced.
• Associate or bachelor’s degree from an accredited nursing school required.
• Minimum of five (5) years in long-term or acute health care required.
• Minimum of five (5) years working as an MDS Nurse in long-term or acute health care
• At least three (3) years of multi-facility, regional MDS experience

Responsibilities

• Consults with and provides technical assistance to the MDS Coordinators through visits and the interpretation or clarification of policies and regulations.
• Trains new MDS Coordinators in conducting resident assessments, developing plans of care, evaluating residents’ responses to interventions and documenting clinical records.
• Trains new MDS Coordinators on the RAI manual and all applicable deadlines for resident assessments and completion of Minimum Data Sets (MDSs).
• Observes MDS and related practices for compliance with standards and regulations.
• Regularly inspects the facility and nursing practices for compliance with standards of nursing practice and federal, state and local regulations
• May be required to assume the role of interim MDS Coordinator, as needed.
• Ability to train facility MDS regarding company best practices including consistent coordination with other members of Compliance Team i.e. DON, BOM, Medical Records, and Therapy to ensure compliant billing.
• Leads the facility management staff and consultants in developing and working from a business plan that focuses on all aspects of facility operations, including clinical management.
• Responsible for developing and implementing appropriate metrics and benchmarks for company's quality of care, against which performance is evaluated.
• Regularly advises and directs Clinical Support Team, Director of Nursing to maximize resident satisfaction and wellbeing.
• Develops and utilizes a standardized process to evaluate and evolve practice to decrease variability and improve the care and safety of patients.
• Responsible for developing, implementing and monitoring quality management policies and procedures for quality data collection and reporting on QM measures.
• Conduct ongoing assessments of the existing eligibility and referrals, case management, disease management systems, and Quality Management programs within each clinical. Provide objective evaluation and recommendations for those systems.
• Review existing clinic information system capabilities for the tracking and monitoring of quality indicators. Make the necessary adaptations for standardized reporting across all centers
• Resident Assessment Instrument (RAI) guidelines are followed in the assigned region with focus on resident care and mixing financial reimbursement through the MDS process. Responsible for ensuring accurate and timely completion of resident assessments, in accordance with Medicare, Medicaid, OBRA and other payer program requirements.
• Utilizes and manages the distribution and utilization of survey information to address areas of importance as defined by our community and service partners.
• Ensure regulatory compliance to all federal, state and local regulations and laws relating to nursing home administration; guide facilities to operate within established company policies and practices
• Ensures each facility maintains building and grounds to appropriate standards and that equipment and work areas are clean, safe and orderly, and any hazardous conditions are addressed; ensure that Universal Precaution and Infection Control, Isolation, Fire Safety and Sanitation practices and procedures are followed.
• Holds the Administrator prepare staff for inspection surveys, instructing staff on matters of conduct and disclosure, being interviewed by inspectors, immediate corrections of problems noted by surveyors, etc. Reviews and reinforces important standards previously cited.
• Participates in the preparation of the Plan of Correction response to an inspection survey and implements any followup QA required for any nursing allegations.
• Provides 24-hour “on call” service to the nursing center in case of emergency.
• Assures that an adequate orientation and in-service training program is provided for MDS personnel.
• Other duties, responsibilities and activities may change or assigned at any time with or without notice.

Skills

RN license

5+ years healthcare

5+ years MDS experience

Regional MDS experience (3+ yrs)

Education

Associate degree in Nursing

Bachelor's degree in Nursing

Job description

OPCO Skilled Management is seeking a Regional Reimbursement Coordinator to lead MDS services across multiple facilities. You will support clinical leadership, train staff on PDPM, PASSAR, and regulatory requirements, and ensure accurate resident assessments and billing alignment.

The role emphasizes training, compliance, and metric development to improve quality of care and financial performance. You will supervise MDS Coordinators, collaborate with the Compliance Team, and maintain adherence to