Regional Clinical Reimbursement Specialist

Act as a clinical resource for MDS Coordinators throughout our Northern Oregon facilities.

Monitor Medicare and Medicaid data for accuracy and reimbursement optimization.

Support accurate and timely claims and billing processes.

Collaborate with Regional Nurse Consultants and IDT members to educate and strengthen systems related to CMS Five-Star Ratings and Quality Measures.

Lead implementation and follow-up audits for new systems, policies, and training programs.

Participate in QAPI efforts including data analysis, root cause evaluations, and measurable action planning.

Assist in preparation for state and federal surveys and participate in internal “mock survey” processes.

Current and active Registered Nurse (RN) license in Oregon or compact state.

Associate or Bachelor’s degree in Nursing from an accredited institution.

3+ years of MDS/RAI experience required.

Previous experience supporting multiple facilities preferred.

In-depth knowledge of PDPM and Oregon’s reimbursement system.

Familiarity with long-term care regulations and standards.

Excellent verbal, written, and interpersonal communication skills.

Ability to travel throughout Northern Oregon, sometimes on short notice.

Highly organized, self-motivated, and detail-oriented.

Proficient in Microsoft Office (Excel, Word, PowerPoint).