Vice President of MDS​/Clinical Reimbursement

We are seeking a dynamic and highly experienced Vice President of MDS/Clinical Reimbursement to lead our organization’s efforts in managing and optimizing Medicare and Medicaid reimbursement strategies related to the Minimum Data Set (MDS) and clinical documentation. This pivotal role requires a strategic thinker with deep expertise in healthcare reimbursement policies, clinical documentation standards, and coding systems. The Vice President will oversee all aspects of clinical reimbursement processes , will travel to multiple facilities throughout the Chicagoland area/suburbs and ensure compliance with federal and state regulations, enhance revenue cycle management, and foster collaboration across clinical, coding, and billing teams.

The ideal candidate will be energized by driving operational excellence and advancing our commitment to delivering exceptional patient care while maximizing reimbursement efficiency.

• Lead the development and implementation of comprehensive MDS/clinical reimbursement strategies aligned with Medicare, Medicaid, and other payer requirements.
• Oversee clinical documentation improvement initiatives to ensure accurate, complete, and compliant medical records that support optimal reimbursement outcomes.
• Manage coding operations involving CPT (Current Procedural Terminology), ICD-9, ICD-10, DRG (Diagnosis-Related Group), and other medical coding standards to ensure precise billing practices.
• Collaborate with health information management teams to maintain adherence to HIPAA regulations, CMS guidelines, and state healthcare policies.
• Drive utilization management efforts by analyzing inpatient and outpatient data, optimizing case management processes, and supporting discharge planning for diverse care settings including acute care, long-term care, home care, hospice, and outpatient services.
• Lead cross-functional teams in conducting documentation reviews, coding audits, and compliance assessments to uphold clinical documentation standards across EMR/EHR systems such as Epic, Cerner, Athenahealth, eClinical
  
  Works, and others.
• Stay abreast of evolving healthcare regulations related to Medicare/Medicaid reimbursement policies, NCQA standards, long-term care regulations, and hospital accreditation requirements to ensure organizational compliance.

• Extensive experience in MDS, PDPM, and clinical reimbursement within skilled nursing
• Multi-site leadership experience strongly preferred
• Deep knowledge of CMS regulations, documentation standards, and reimbursement audits
• Proven ability to lead teams, influence outcomes, and drive performance at a regional or corporate level
• Extensive experience in managed care environments with a strong background in Medicare and Medicaid reimbursement policies.
• Proven expertise in MDS processes within long-term care facilities or skilled nursing settings; ICU or trauma center experience is highly desirable.
• In-depth knowledge of CPT coding, ICD-9/10 coding systems, DRG assignment, and utilization review procedures.
• Demonstrated ability to lead clinical documentation improvement programs aligned with healthcare quality standards such as NCQA or CMS guidelines.
• Familiarity with EMR/EHR systems including Epic, Cerner, Athenahealth or eClinical
  
  Works; proficiency in Microsoft Office Suite is essential.
• Strong understanding of health regulation policies including HIPAA, CMS regulations, state healthcare laws, and long-term care regulations.
• Exceptional leadership skills with experience managing multidisciplinary teams across inpatient and outpatient settings including nursing homes, hospitals (Level I & II trauma centers), pediatric units (PICU), emergency departments (Level I Trauma Center), hospice programs or primary care clinics.
• Critical thinking skills combined with physiology knowledge and expertise in medical terminology for effective documentation review and case management.