At Limitlessli we specialize in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. Leveraging our extensive global network, we connect clients with highly qualified professionals, offering tailored services to meet our clients' unique business needs.
The Opportunity
We are seeking an experienced and results-driven Vice President of Clinical Reimbursement - MDS to lead and oversee the reimbursement strategy and operations related to the Minimum Data Set (MDS) in long-term care settings through remote workers following the RAI Guidelines and CMS Regulations.
The ideal candidate will have in-depth knowledge of MDS processes, case mix index for skilled nursing facilities (SNFs), and reimbursement methodologies, with a proven track record of improving financial outcomes while ensuring compliance with regulatory requirements. The VP of Clinical Reimbursement will work closely with senior leadership, clinical teams, and external stakeholders to optimize reimbursement, enhance care quality, and drive operational efficiencies.
This position is remote and offers you the flexibility of working from home.
What You’ll Do:
1. Leadership and Strategic Direction
- Lead the development, implementation, and continuous improvement of MDS-related reimbursement strategies for long-term care facilities
- Oversee the MDS process, ensuring accurate and timely completion of assessments, coding, and data submission to maximize reimbursement
- Collaborate with clinical and administrative teams to develop strategies that align care delivery with optimal reimbursement opportunities
- Provide leadership and guidance to MDS coordinators, billing, and clinical staff on best practices for MDS documentation and reimbursement
2. Financial Management and Optimization
- Analyze reimbursement trends and implement strategies to improve payer mix, case mix index (CMI), and overall revenue capture for long-term care operations
- Review and interpret payer policies, regulatory updates, and billing codes to ensure facilities are compliant while optimizing financial outcomes
- Drive continuous improvement initiatives that streamline workflows, reduce inefficiencies, and enhance reimbursement accuracy
- Monitor financial performance relative to MDS coding and reimbursement, ensuring adherence to budgetary goals
3. Compliance and Regulatory Oversight
- Ensure that all MDS-related processes are compliant with federal and state regulations, including CMS guidelines and reimbursement rules
- Stay current with changes in reimbursement policies, CMS regulations, and industry trends, adjusting strategies and processes accordingly
- Partner with internal audit and compliance teams to ensure proper documentation practices and prevent issues related to audits or billing disputes
4. Collaboration and Communication
- Serve as a key liaison between clinical, operational, and financial departments, ensuring effective communication and collaboration on reimbursement-related issues
- Advise the executive leadership team on financial and clinical trends related to MDS reimbursement and help inform strategic decisions
- Foster positive relationships with external payers, auditors, and regulatory agencies to ensure timely and accurate reimbursement
5. Data Analysis and Reporting
- Lead the data analysis and review of data reports related to MDS, reimbursement performance, and case mix analysis
- Use data analytics to identify opportunities for improvement and create actionable insights that drive financial performance and quality outcomes through process development and implementation
- Provide regular reports to senior leadership on reimbursement outcomes, trends, and areas for improvement
6. Staff Development and Training
- Build and lead a high-performing team of remote MDS professionals through recruitment, training, mentorship, and performance management
Education:
Associate Degree in Nursing, Healthcare Administration, Business, or a related field (Bachelor’s degree preferred)
Experience:
- Minimum of 5 years of progressive experience in healthcare reimbursement, specifically related to MDS in long-term care settings with proven success on CMI and PDPM
- At least 5 years in a senior leadership role with direct responsibility for MDS, reimbursement strategy, or financial management in skilled nursing or long-term care
- In-depth understanding of MDS processes, case mix, and the regulatory environment for long-term care facilities
- Experience with CMS regulations, payer contracting, and reimbursement systems (e.g., PDPM, RUGs, HIPPS codes)
Skills and Competencies:
- Strong leadership and management skills, with the ability to influence and collaborate across departments
- Exceptional analytical, financial, and problem-solving skills
- In-depth knowledge of regulatory and compliance standards in the long-term care and skilled nursing industry
- Ability to interpret complex data and translate it into actionable strategies
- Excellent communication skills, both written and verbal, with the ability to present to senior leadership and external stakeholders
- Proficiency with MDS software, Electronic Health Record (EHR) systems, and reimbursement software
Certifications:
- Certification in MDS or related fields (e.g., RNAC, CMAC, or RAC-CT) is preferred but not required
Preferred Qualifications:
- Experience in a multi-facility or multi-state long-term care operation
- Knowledge of emerging trends in value-based care and the shift towards quality-focused reimbursement models
- Prior experience with private and governmental payer negotiations and relationships
Personal Attributes:
- Results-oriented with a focus on operational efficiency and financial outcomes
- Ability to manage and prioritize multiple initiatives in a fast-paced environment
- Detail-oriented, with a commitment to accuracy and compliance
- Strong interpersonal skills, with the ability to build relationships and influence change across all levels of the organization
Hours:
US Eastern Standard Time (EST) - 9am to 6pm
Why Join Us?
This is an exciting opportunity to be part of a dynamic organization focused on providing high-quality care in the long-term care industry. As the VP of Clinical Reimbursement, you will play a critical role in shaping the financial and operational future of the organization, ensuring that we are reimbursed fairly while maintaining the highest standards of patient care.
Essential requirements:
You will need to have some essential tools – a reliable computer and noise-canceling headset, a second monitor for enhanced productivity, and a stable internet connection. You’ll also be required to have a backup internet connection, ensuring that you’re well-equipped to complete your work seamlessly.
Don't miss out on this opportunity – apply now and become a valuable member of the Limitlessli team! If you're interested in what you have read, then we invite you to take the next step and submit your application.