Regional Reimbursement Specialist

Job Title: Regional Reimbursement Specialist – Skilled Nursing Facilities Location: East Texas (Travel Required) Job Type: Full-Time Reports To: VP of Operations/ CEO Position Summary: We are seeking a detail-oriented and knowledgeable Regional Reimbursement Specialist to support Skilled Nursing Facilities (SNFs) in East Texas. This role is responsible for optimizing reimbursement, ensuring accurate and compliant billing practices, and providing guidance on Medicare, Medicaid, and managed care reimbursement regulations across multiple SNFs within the region. Key Responsibilities: • Oversight of Reimbursement Processes: • Ensure accurate and timely MDS submissions and billing processes across assigned facilities. • Review and monitor Medicare and Medicaid reimbursement systems to maximize appropriate payments. • Assist with PDPM-related case mix reviews and validations. • Audit and Compliance: • Conduct routine audits of billing and documentation practices. • Identify compliance issues and recommend corrective actions to maintain regulatory standards. • Provide education and support during external audits and surveys. • Training and Support: • Serve as a resource for facility-based staff, including MDS Coordinators, Business Office Managers, and Administrators. • Provide on-site and remote training on reimbursement best practices, regulatory changes, and software systems. • Monitor regulatory updates and communicate changes in federal and state billing policies. • Data Analysis and Reporting: • Analyze reimbursement trends, missed revenue opportunities, and denial patterns. • Prepare reports and summaries for regional and corporate leadership. • Support accurate reporting of Quality Measures (QMs) and Five-Star data where applicable. • Collaboration: • Work closely with interdisciplinary teams to ensure clinical documentation supports billing. • Collaborate with the finance, clinical, and operations teams to drive performance and compliance. Qualifications: • Education: LVN/RN licensure required in the state of Texas. • Experience: • Minimum of 3 years of experience in SNF reimbursement. • Strong understanding of MDS 3.0, PDPM, Medicare Part A & B, Medicaid, and managed care plans. • Experience with electronic health records (EHR) systems and billing platforms. • Licenses/Certifications: • RAC-CT, CHC, or similar certification strongly preferred. • LVN/RN license is required. Skills and Competencies: • In-depth knowledge of long-term care reimbursement methodologies. • Strong analytical, organizational, and communication skills. • Ability to manage multiple facilities and travel throughout East Texas. • Proficiency in Microsoft Excel, Word, and PowerPoint. Travel Requirements: • Up to 75% travel across East Texas to visit facilities, provide support, and conduct audits. Benefits: • Competitive salary based on experience • Health, dental, and vision insurance • 401(k) with company match • Paid time off and holidays • Continuing education support Apply tot his job Apply To this Job