Field Clinical Reimbursement Coordinator

Field Clinical Reimbursement Coordinator Position 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.

• 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.

• 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.

• 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.

• 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 over coding 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.

• 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.

• Provide one‑on‑one and group education to MDS Coordinators and interdisciplinary team members.
• Reinforce MDS, PDPM, Medicaid,…