About this opportunity
Stellar Health Group lists this Remote Director of Clinical Reimbursement opportunity in northern, Kentucky. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Director of Clinical Reimbursement – MDS/PDPM
Remote | Massachusetts or Vermont
About Stellar Health Group
Stellar Health Group is a growing healthcare organization dedicated to delivering high-quality skilled nursing and post-acute care. Our teams focus on strong clinical outcomes, regulatory compliance, operational excellence, and accurate reimbursement across our portfolio of facilities.
We are seeking an experienced Director of Clinical Reimbursement – MDS/PDPM to provide leadership and oversight across multiple skilled nursing facilities in Massachusetts and Vermont.
Position Summary
The Director of Clinical Reimbursement – MDS/PDPM is responsible for overseeing clinical reimbursement, MDS, PDPM, case-mix management, and Medicare/Medicaid compliance across a multi-site skilled nursing portfolio.
This position ensures accurate clinical documentation and coding, appropriate reimbursement, timely assessments, regulatory compliance, and successful audit outcomes.
The Director works closely with MDS Coordinators, Directors of Rehabilitation, clinical leadership, respiratory teams, facility administrators, and finance leadership to monitor reimbursement performance, strengthen documentation practices, identify compliance risks, and support regulatory and survey readiness.
This role will also lead ADR, TPE, and RAC audit responses , oversee CMI and PDPM processes, support MDS staffing and education, and coordinate reimbursement-related operations across facilities.
Key Responsibilities
MDS, PDPM & Clinical Reimbursement
Oversee MDS accuracy, PDPM compliance, CMI trends, and case-mix capture across facilities.
Lead weekly PDPM and CMI review processes, including audit alerts, IPA reviews, and ARD scheduling.
Review Section GG, active diagnoses, behavioral/SUD add-ons, and other 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 appropriate continued Medicare Part A stays.
Maintain PDPM, CMI, and reimbursement tracking tools.
Identify reimbursement trends, risks, and opportunities for improvement.
Audit & Regulatory Compliance
Lead ADR, TPE, and RAC audit responses from record retrieval through submission.
Coordinate documentation and record requests with facilities, vendors, and external contractors.
Maintain audit tracking logs and daily chart recaps.
Oversee QRP validation audits, QIES reporting, and quality compliance reviews.
Support mock surveys, infection control rounds, and overall survey readiness.
Rehabilitation Operations
Lead weekly QRM meetings and monthly DOR calls.
Monitor rehabilitation statistics, utilization, budgets, GG scores, therapy triple-checks, and Part B billing.
Partner with recruiting regarding rehabilitation staffing needs and onboarding.
Support DOR onboarding, contractor interviews, and documentation compliance.
Monitor therapy authorization and appointment processes.
Respiratory Program Oversight
Oversee respiratory documentation, billing, CPT/coding compliance, and ARD coordination.
Monitor trach/vent census and validate UB billing against supporting documentation.
Lead recurring compliance meetings with respiratory teams.
Coordinate MDS and respiratory workflows to support accurate documentation and reimbursement.
Medicaid & Financial Operations
Oversee MassHealth enrollment, MDS audits, and MMIS billing reconciliation.
Review scrubber reports and payor setup within PCC.
Participate in financial and ACO review meetings.
Monitor reimbursement trends and support accurate financial reporting.
Systems & Facility Implementation
Lead onboarding of new facilities, including PCC setup, assessments, workflows, and staff education.
Establish standardized reimbursement and documentation processes across facilities.
Partner with clinical, operational, finance, rehabilitation, respiratory, and MDS leadership on performance improvement initiatives.
Qualifications
Bachelor's degree in Nursing, Healthcare Administration, Health Information Management, or a related field preferred.
Significant experience in skilled nursing reimbursement, MDS, PDPM, and Medicare/Medicaid processes.
Strong knowledge of MDS 3.0, PDPM, CMI, Medicare Part A, Medicaid, and reimbursement regulations.
Experience managing ADR, TPE, RAC, or other Medicare audits.
Experience overseeing MDS and reimbursement operations across multiple skilled nursing facilities preferred.
Strong understanding of Section GG, clinical documentation, coding accuracy, and triple-check processes.
Experience with PointClickCare (PCC) preferred.
Strong analytical, organizational, communication, and leadership skills.
Ability to work independently in a fully remote environment while collaborating effectively with facility and corporate teams.
Must be located in Massachusetts or Vermont .
Benefits
Competitive Salary
Weekly Pay
Medical, Dental, and Vision Insurance
Short- and Long-Term Disability Insurance
Paid Time Off (PTO) for Full-Time Employees
401(k)
Paid Holidays
Professional Education and Development Opportunities
Supportive Leadership Team
Remote Work Environment
Why Join Stellar Health Group?
Join Stellar Health Group and play a key leadership role in strengthening reimbursement accuracy, regulatory compliance, and clinical operations across our skilled nursing facilities. This is an opportunity to make a meaningful impact across multiple facilities while partnering with experienced clinical and operational leaders.
Stellar Health Group is an Equal Opportunity Employer.
#HP123 Director of Clinical Reimbursement – MDS/PDPM
#HP123
About Stellar Health Group
Stellar Health Group is a growing healthcare organization dedicated to delivering high-quality skilled nursing and post-acute care. Our teams focus on strong clinical outcomes, regulatory compliance, operational excellence, and accurate reimbursement across our portfolio of facilities.
We are seeking an experienced Director of Clinical Reimbursement – MDS/PDPM to provide leadership and oversight across multiple skilled nursing facilities in Massachusetts and Vermont.
Position Summary
The Director of Clinical Reimbursement – MDS/PDPM is responsible for overseeing clinical reimbursement, MDS, PDPM, case-mix management, and Medicare/Medicaid compliance across a multi-site skilled nursing portfolio.
This position ensures accurate clinical documentation and coding, appropriate reimbursement, timely assessments, regulatory compliance, and successful audit outcomes.
The Director works closely with MDS Coordinators, Directors of Rehabilitation, clinical leadership, respiratory teams, facility administrators, and finance leadership to monitor reimbursement performance, strengthen documentation practices, identify compliance risks, and support regulatory and survey readiness.
This role will also lead ADR, TPE, and RAC audit responses , oversee CMI and PDPM processes, support MDS staffing and education, and coordinate reimbursement-related operations across facilities.
Key Responsibilities
MDS, PDPM & Clinical Reimbursement
Oversee MDS accuracy, PDPM compliance, CMI trends, and case-mix capture across facilities.
Lead weekly PDPM and CMI review processes, including audit alerts, IPA reviews, and ARD scheduling.
Review Section GG, active diagnoses, behavioral/SUD add-ons, and other 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 appropriate continued Medicare Part A stays.
Maintain PDPM, CMI, and reimbursement tracking tools.
Identify reimbursement trends, risks, and opportunities for improvement.
Audit & Regulatory Compliance
Lead ADR, TPE, and RAC audit responses from record retrieval through submission.
Coordinate documentation and record requests with facilities, vendors, and external contractors.
Maintain audit tracking logs and daily chart recaps.
Oversee QRP validation audits, QIES reporting, and quality compliance reviews.
Support mock surveys, infection control rounds, and overall survey readiness.
Rehabilitation Operations
Lead weekly QRM meetings and monthly DOR calls.
Monitor rehabilitation statistics, utilization, budgets, GG scores, therapy triple-checks, and Part B billing.
Partner with recruiting regarding rehabilitation staffing needs and onboarding.
Support DOR onboarding, contractor interviews, and documentation compliance.
Monitor therapy authorization and appointment processes.
Respiratory Program Oversight
Oversee respiratory documentation, billing, CPT/coding compliance, and ARD coordination.
Monitor trach/vent census and validate UB billing against supporting documentation.
Lead recurring compliance meetings with respiratory teams.
Coordinate MDS and respiratory workflows to support accurate documentation and reimbursement.
Medicaid & Financial Operations
Oversee MassHealth enrollment, MDS audits, and MMIS billing reconciliation.
Review scrubber reports and payor setup within PCC.
Participate in financial and ACO review meetings.
Monitor reimbursement trends and support accurate financial reporting.
Systems & Facility Implementation
Lead onboarding of new facilities, including PCC setup, assessments, workflows, and staff education.
Establish standardized reimbursement and documentation processes across facilities.
Partner with clinical, operational, finance, rehabilitation, respiratory, and MDS leadership on performance improvement initiatives.
Qualifications
Bachelor's degree in Nursing, Healthcare Administration, Health Information Management, or a related field preferred.
Significant experience in skilled nursing reimbursement, MDS, PDPM, and Medicare/Medicaid processes.
Strong knowledge of MDS 3.0, PDPM, CMI, Medicare Part A, Medicaid, and reimbursement regulations.
Experience managing ADR, TPE, RAC, or other Medicare audits.
Experience overseeing MDS and reimbursement operations across multiple skilled nursing facilities preferred.
Strong understanding of Section GG, clinical documentation, coding accuracy, and triple-check processes.
Experience with PointClickCare (PCC) preferred.
Strong analytical, organizational, communication, and leadership skills.
Ability to work independently in a fully remote environment while collaborating effectively with facility and corporate teams.
Must be located in Massachusetts or Vermont .
Benefits
Competitive Salary
Weekly Pay
Medical, Dental, and Vision Insurance
Short- and Long-Term Disability Insurance
Paid Time Off (PTO) for Full-Time Employees
401(k)
Paid Holidays
Professional Education and Development Opportunities
Supportive Leadership Team
Remote Work Environment
Why Join Stellar Health Group?
Join Stellar Health Group and play a key leadership role in strengthening reimbursement accuracy, regulatory compliance, and clinical operations across our skilled nursing facilities. This is an opportunity to make a meaningful impact across multiple facilities while partnering with experienced clinical and operational leaders.
Stellar Health Group is an Equal Opportunity Employer.
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Who can apply
Review the original listing for work authorization, qualifications and employer requirements.