THIS IS FOR A FUTURE OPENING

Regional Clinical Reimbursement Consultant - State Veterans Homes STGi is seeking qualified candidates for this position in connection with an active Request for Proposals (RFP). Hiring for this role is contingent upon STGi's selection as the successful awardee.

JOB SUMMARY

The Regional Clinical Reimbursement Consultant (R CRC ) provides leadership and oversight of clinical reimbursement processes across multiple long-term care facilities within an assigned region. This role ensures accurate and compliant MDS completion, optimized reimbursement under PDPM, regulatory compliance, and consistent application of best practices while partnering with clinical, financial, and operational leaders to drive outcomes. Travel is required and is e xtensive throughout assigned region.

ESSENTIAL FUNCTIONS

Clinical Reimbursement & PDPM Oversight Oversee clinical reimbursement operations across multiple skilled nursing facilities Ensure accurate , timely , and compliant completion of MDS assessments in accordance with CMS requirements Monitor PDPM performance, case-mix accuracy, and reimbursement trends Identify opportunities to optimize reimbursement while maintaining clinical integrity and compliance MDS & Documentation Support Provide guidance and oversight to MDS Coordinators and facility leadership Ensure interdisciplinary documentation supports clinical conditions, diagnoses, and care needs Support MDS scheduling, care area assessments (CAAs), and care planning processes Compliance & Audit Management Ensure compliance with federal and state regulations, RAI Manual, and payer requirements Support internal and external audits, including medical record reviews and ADRs Lead corrective action plans related to MDS, documentation, and reimbursement findings Education & Training Develop and deliver ongoing education related to

PDPM, MDS, ICD-10

coding, and documentation standards Support onboarding and competency development of MDS and clinical reimbursement staff Stay current on CMS updates, rule changes, and industry best practices Reporting & Analytics Review and analyze reimbursement and quality data, including PDPM components, case-mix indices, and revenue impacts Provide regular reporting and recommendations to regional and corporate leadership Partner with business office and clinical teams to resolve billing, denials, and reimbursement issues Collaboration & Leadership Work closely with Regional Clinical, Operations, and Finance leadership Serve as a regional resource for reimbursement-related questions and problem resolution Promote a culture of compliance, accuracy, and continuous improvement