Regional Director of Clinical Reimbursement/ Regional MDS

Overview

We are seeking a dynamic and highly skilled Regional Director of Clinical Reimbursement and MDS (Minimum Data Set) to lead our clinical reimbursement strategies across multiple healthcare facilities. This pivotal role involves overseeing the accurate and compliant documentation, coding, and reimbursement processes related to Medicare, Medicaid, and other managed care programs. The ideal candidate will possess extensive experience in clinical documentation improvement, utilization management, and long-term care regulations, ensuring optimal reimbursement while maintaining the highest standards of patient care. Join us to drive excellence in clinical financial performance and elevate the quality of care delivered to our diverse patient populations.

Duties

• Lead the development and implementation of clinical reimbursement strategies aligned with federal and state healthcare regulations, including CMS guidelines.
• Oversee the accurate completion and review of MDS assessments, ensuring compliance with all regulatory standards such as HEDIS, NCQA, and long-term care regulations.
• Manage coding processes utilizing CPT, ICD-9, ICD-10, DRG, and other medical coding systems to maximize reimbursement opportunities.
• Collaborate with interdisciplinary teams—including nursing, case management, medical records, and billing—to ensure precise documentation that supports appropriate reimbursement levels.
• Conduct audits of medical records and documentation review processes to identify areas for improvement in clinical documentation standards and compliance.
• Provide leadership for utilization review activities, discharge planning, and case management to optimize patient care pathways while adhering to Medicare and Medicaid policies.
• Facilitate training sessions on health regulation policies, ICD coding updates, EMR/EHR systems such as Epic or Cerner, and HIPAA compliance to enhance staff knowledge and performance.

Requirements

• Proven experience in managed care environments with a strong understanding of Medicare regulations, long-term care regulations, and hospital-based reimbursement practices.
• Extensive knowledge of clinical documentation improvement techniques, utilization management, and medical coding including CPT, ICD-9/10 codes, DRGs, HEDIS standards, and CMS guidelines.
• Demonstrated expertise in EMR/EHR systems such as Epic, Cerner, Athenahealth or eClinicalWorks; proficiency in Microsoft Office Suite is essential.
• Background in acute care settings such as ICU or trauma centers is highly desirable; inpatient or outpatient experience is also valuable.
• Strong understanding of health information management practices related to medical records review, documentation standards, anatomy/physiology knowledge, and healthcare policies at the state and federal levels.
• Excellent leadership skills with the ability to manage cross-functional teams across multiple sites while fostering a culture of compliance and continuous improvement.
• Relevant certifications such as Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or equivalent are preferred.

Join us to be at the forefront of clinical reimbursement excellence! This role offers an exciting opportunity to influence healthcare delivery through strategic leadership while ensuring compliance with evolving regulations—making a real difference in patient outcomes and organizational success.

Pay: $90,000.00 - $115,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Travel reimbursement
• Vision insurance

Work Location: In person

Salary : $90,000 - $115,000