Medical Coder

Job Title:

Director Reimbursement, MDS

Location:

Waukesha County, Wi (Onsite)

Type:
Full-Time, Permanent/Direct Hire

Benefits:
Health, Dental and Vision insurances, 401(k), STD, LTD, etc.

We are seeking an experienced Director, Clinical Reimbursement MDS to lead and support clinical reimbursement processes across multiple skilled nursing facilities. This role is responsible for ensuring accurate MDS completion, optimizing reimbursement, and maintaining compliance with federal and state regulations while supporting strong clinical outcomes.

• Oversee and support the accurate and timely completion of MDS assessments
• Provide guidance, training, and mentorship to MDS Coordinators and clinical staff
• Monitor and analyze reimbursement metrics (including CMI) to identify trends and opportunities
• Conduct audits of MDS and reimbursement practices to ensure accuracy and compliance
• Partner with clinical and operational leaders to improve quality outcomes and financial performance
• Ensure adherence to current Medicare and Medicaid regulations
• Serve as a subject matter expert on MDS, ICD coding, and reimbursement best practices
• Support denials management and appeals processes
• Track and evaluate Quality Measures (QMs) and their impact on performance ratings
• Lead education initiatives related to regulatory changes and reimbursement strategies

• Active Registered Nurse (RN) license
• RAC-CT certification required
• 3–5+ years of MDS and clinical reimbursement experience in a skilled nursing setting
• Strong knowledge of Medicare/Medicaid reimbursement, CMI, and regulatory requirements
• Proven ability to lead, mentor, and support clinical teams
• Strong analytical, organizational, and communication skills
• Ability to manage multiple priorities in a fast-paced environment