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Reimbursement Oversight

Educating & Connecting

  • Interface with community leaders and clients serving as a content expert for Clinical, MDS, and reimbursement

  • Work directly with MDS Coordinators to enhance knowledge and skills to improve clinical outcomes, compliance, quality reporting, and correct coding

  • Provide education and auditing of reimbursement policies and procedures including documentation, compliance, and operations


  • Patient-Driven Payment Model (PDPM) and Case-mix Index (CMI) performance review and strategies for improved compliance and revenue

  • Assist in developing an effective Resident Assessment Instrument (RAI) process

  • Managed Care and 3rd party contract reimbursement,5 Star, QAPI and Quality Measures (QMs)

  • Provide on-site support services, consultation, and recommendations for communities and clients, as requested


  • Consult clients regarding compliance with policies and procedures as it relates to reimbursement systems to ensure compliance with managed care organizations (MCOs), federal and state programs

  • Conduct audits at communities to assure standards, policies and procedures are being followed

  • Remain informed regarding regulatory changes and consult in developing and implementing procedures for communities and clients to remain in compliance

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