Field Clinical Reimbursement Coordinator

Job Description

Job Description Field Clinical Reimbursement CoordinatorPosition Summary

The Field Clinical Reimbursement Coordinator (FCRC) is a field-based clinical reimbursement specialist who provides hands-on MDS, reimbursement, documentation, education, and operational support to skilled nursing facilities throughout an assigned geographic market.

The Field Clinical Reimbursement Coordinator serves as a flexible clinical reimbursement resource and may be deployed to facilities experiencing MDS vacancies, staffing transitions, increased workload, reimbursement performance concerns, audit needs, new acquisitions, regulatory challenges, or other operational priorities.

This is a predominantly facility-facing position requiring a minimum of four (4) days per week of on-site facility presence. The position requires extensive travel and the ability to quickly assess facility needs, establish priorities, work collaboratively with facility teams, and provide both immediate operational support and longer-term process improvement.

The ideal candidate is an experienced MDS professional who is highly independent, adaptable, organized, clinically knowledgeable, and comfortable working in multiple facilities and environments.

Essential Duties and ResponsibilitiesMDS and Reimbursement Support

• Provide direct MDS and clinical reimbursement support to assigned skilled nursing facilities.

• Complete and/or assist with MDS assessments when necessary due to vacancies, leaves of absence, increased workload, or other operational needs.

• Review assessments for accuracy, completeness, timeliness, and appropriate supporting documentation.

• Assist facilities with Medicare Part A and PDPM processes.

• Support Texas Medicaid PDPM-LTC reimbursement processes.

• Review resident clinical information to identify appropriate reimbursement opportunities supported by the medical record.

• Assist facility teams with accurate acuity capture and Case Mix Index management.

Vacancy and Operational Coverage

• Provide temporary MDS coverage for facilities experiencing staffing vacancies or transitions.

• Assist facilities with maintaining assessment schedules and regulatory compliance during periods of staffing disruption.

• Evaluate outstanding assessments, ARDs, completion dates, transmission status, and other MDS workflow priorities upon deployment to a facility.

• Help stabilize facility reimbursement systems before transitioning responsibilities back to permanent facility personnel.

• Support newly hired MDS Coordinators during orientation and transition when requested.

Clinical Documentation Review

• Review clinical documentation to ensure that coded diagnoses, services, functional status, clinical conditions, and other reimbursement drivers are adequately supported.

• Work with nursing, therapy, physicians/providers, dietary, social services, and other interdisciplinary team members to strengthen documentation processes.

• Identify documentation gaps that may create reimbursement or compliance risk.

• Provide real-time education and coaching regarding documentation expectations.

Auditing and Compliance

• Conduct focused MDS and reimbursement audits as directed by the Clinical Reimbursement Manager.

• Validate MDS coding against supporting clinical documentation.

• Identify missed reimbursement opportunities as well as potential overcoding or unsupported reimbursement.

• Assist with corrective action plans resulting from internal or external audit findings.

• Support facilities with ADRs, medical reviews, denials, and other reimbursement-related reviews as assigned.

• Maintain reimbursement integrity by ensuring that coding and payment are supported by the resident’s clinical condition and medical record.

Quality Measures and QIPP

• Assist facilities with identifying MDS-related Quality Measure opportunities.

• Review MDS coding and supporting documentation that may affect Quality Measure performance.

• Support facility and regional initiatives related to QIPP and other Texas reimbursement and quality programs.

• Participate in targeted improvement initiatives when assigned.

Education and Staff Development

• Provide one-on-one and group education to MDS Coordinators and interdisciplinary team members.

• Reinforce MDS, PDPM, Medicaid, documentation, and reimbursement best practices.

• Provide hands-on mentoring to newly hired or developing MDS Coordinators.

• Communicate recurring educational needs and operational concerns to the Clinical Reimbursement Manager.

Communication and Reporting

• Maintain regular communication with the Clinical Reimbursement Manager regarding assigned facilities.

• Provide concise updates regarding facility status, identified risks, reimbursement opportunities, staffing concerns, and recommended follow-up.

• Escalate significant compliance, documentation, or reimbursement concerns promptly.

• Document facility support activities and outcomes as required.

QualificationsRequired

• Current RN or LVN/LPN license in good standing.

• Minimum 2–3 years of skilled nursing MDS experience.

• Strong working knowledge of the MDS 3.0 and RAI Manual.

• Working knowledge of Medicare Part A and PDPM.

• Strong clinical assessment and documentation-review skills.

• Ability to independently manage an MDS schedule and assessment process.

• Strong organizational, communication, and problem-solving skills.

• Ability to quickly adapt to different facilities, leadership teams, and operational environments.

• Ability and willingness to maintain the required minimum four (4) facility-facing days per week.

• Ability and willingness to travel extensively, including overnight travel when necessary.

• Valid driver's license and ability to meet applicable company travel requirements.

Preferred

• RAC-CT or equivalent MDS certification.

• Experience with Texas Medicaid PDPM-LTC.

• Experience with QIPP.

• Experience with PointClickCare or similar electronic health record systems.

• Prior regional, float, traveling MDS, consulting, or multi-facility experience.

• Experience providing temporary MDS coverage during vacancies or operational transitions.

Core Competencies

• Advanced MDS knowledge

• Clinical reimbursement knowledge

• Independent decision-making

• Clinical documentation review

• Audit and compliance awareness

• Adaptability

• Time management

• Staff education and coaching

• Problem solving

• Professional communication

• Ability to function effectively in changing environments

Travel and Field Presence Requirements

• The Field Clinical Reimbursement Coordinator is specifically designed as a traveling, facility-facing field position and is expected to maintain a consistent and visible presence within assigned skilled nursing facilities.

• The Field Clinical Reimbursement Coordinator is required to be facility-facing a minimum of four (4) days per week.

• Facility-facing days are expected to involve direct, on-site engagement with MDS Coordinators, facility leadership, nursing, interdisciplinary teams, and other operational partners.

• Field activities may include MDS support and completion, reimbursement reviews, clinical documentation audits, staff education and coaching, Quality Measure and QIPP initiatives, vacancy coverage, performance improvement activities, and follow-up on identified opportunities.

• The FCRC will routinely travel among skilled nursing facilities within the assigned geographic market and may be temporarily deployed outside the primary market based on operational needs.

• Travel may include same-day travel, extended driving, and overnight stays depending on facility location and assignment.

• Facility assignments and travel priorities may change based on reimbursement performance, compliance risk, staffing needs, MDS vacancies, facility performance, operational priorities, and other identified needs.

• Non-facility-facing time may be utilized for reporting, data analysis, virtual meetings, audit follow-up, education development, administrative responsibilities, and other departmental priorities.

• This position is not designed as a primarily remote role. A minimum of four facility-facing days per week is an essential expectation of the Field Clinical Reimbursement Coordinator position.

Position Objective

• The Field Clinical Reimbursement Coordinator provides the organization with a flexible, highly skilled reimbursement resource capable of responding quickly when facilities require additional support.

• Success in this role means leaving a facility stronger than it was upon arrival—assessments current, reimbursement accurate, documentation strengthened, compliance risks identified, staff educated, and sustainable processes established.

• The Field Clinical Reimbursement Coordinator is not simply temporary MDS coverage. The position serves as a field extension of the Clinical Reimbursement Department, helping protect reimbursement integrity, strengthen facility performance, and maintain operational continuity throughout the portfolio.