Regional MDS & Reimbursement Specialist

Alliance Health & Human Services; Southborough (MA); On-site; USD 90,000 - 120,000; Full time

Job summary

ALLIANCE HEALTH MANAGEMENT SERVICES seeks a Regional Clinical Reimbursement Specialist to oversee MDS/RAI processes, ensure CMS guideline compliance, and coordinate with facility teams for accurate reimbursement in long-term care settings.

The role requires a MA nursing license, 2+ years of LTAC experience, and RAC-CT preferred, with strong regulatory knowledge and collaboration across corporate and facility levels.

Qualifications

• Minimum 2 years clinical experience in a long-term care setting.
• Prior MDS/RAI experience.
• Knowledge of Medicare and Medicaid regulations and coverage guidelines related to skilled nursing.

Responsibilities

• Review current CR Policies and Procedures; ensure compliance with policy.
• Evaluate and audit MDS submissions and documentation for accuracy and timeliness.
• Coordinate with CR staff for problem solving and real-time education as needed.
• Lead short stay PDPM PPS MDS process or OBRA-based MDS processes.
• Assist with end-of-month processes and ARD requests from third-party payers.
• Provide CR transition training and support to the organization.

Skills

Clinical assessment

MDS/RAI experience

Medicare/Medicaid regs

Regulatory compliance

Education

RN

BSN

LPN

Job description

ALLIANCE HEALTH MANAGEMENT SERVICES seeks a Regional Clinical Reimbursement Specialist to oversee MDS/RAI processes, ensure CMS guideline compliance, and coordinate with facility teams for accurate reimbursement in long-term care settings.

The role requires a MA nursing license, 2+ years of LTAC experience, and RAC-CT preferred, with strong regulatory knowledge and collaboration across corporate and facility levels.