Director of Clinical Reimbursement & Revenue Optimization

We are seeking a Director of Clinical Reimbursement & Revenue Optimization to join our Retirement Services team.  As a Director of Clinical Reimbursement & Revenue Optimization, you will serve as the enterprise leader responsible for advancing Buckner Retirement Services' reimbursement operating model by integrating clinical operations, reimbursement strategy, revenue integrity, audit oversight, standardized workflows, analytics, and leadership development to improve organizational performance, financial sustainability, and regulatory compliance. Join our team and inspire happiness in the lives of others!

What You'll Do:

• Enterprise Reimbursement Operations
  • Establish and lead enterprise reimbursement standards, governance, and operational initiatives to drive consistency, best practices, and scalable reimbursement processes across all Buckner Retirement Services (BRS) skilled nursing communities.
• Revenue Integrity & Financial Performance
  • Drive revenue integrity and reimbursement optimization through denial reduction, revenue recovery, KPI monitoring, and strategic partnership with Finance.
• Enterprise Transformation
  • Lead enterprise transformation initiatives through standardization, system redesign, change management, acquisition integration, process improvement, and scalable operational solutions.
• Clinical Reimbursement Leadership
  • Provide enterprise leadership for skilled nursing reimbursement programs by developing reimbursement strategies, ensuring compliance and revenue integrity, monitoring regulatory and payer changes, and serving as the primary reimbursement resource for BRS communities.
• Reimbursement, MDS & Performance Optimization
  • Provide enterprise oversight of MDS processes, assessment scheduling, coding accuracy, submission practices, and documentation integrity to promote consistency, regulatory compliance, and reimbursement optimization across all skilled nursing operations.
    • Lead enterprise standardization of PDPM reimbursement practices, ensuring consistent interpretation and application of CMS requirements while identifying opportunities to improve reimbursement accuracy, reduce revenue leakage, and strengthen revenue integrity.
    • Monitor and analyze Case Mix Index (CMI), PDPM performance, reimbursement trends, and key financial indicators to identify opportunities for reimbursement optimization, operational improvement, and enterprise performance enhancement.
    • Evaluate utilization of PPS, IPA, OBRA, and other required assessments to ensure appropriate assessment timing, regulatory compliance, reimbursement integrity, and alignment with CMS requirements.
    • Collaborate with MDS, nursing, therapy, and interdisciplinary teams to improve Section GG documentation accuracy, functional assessment consistency, and interdisciplinary documentation practices that support reimbursement integrity, audit readiness, and clinical outcomes.
    • Partner with Clinical Operations and Quality leadership to monitor quality measures, Value-Based Purchasing (VBP), Quality Reporting Program (QRP) measures, and other reimbursement-related performance indicators, identifying opportunities to improve documentation, operational processes, financial performance, and quality outcomes.
    • Develop and implement enterprise audit, education, and performance monitoring processes to promote consistent assessment practices, documentation standards, and reimbursement performance across all communities.
    • Analyze enterprise reimbursement and MDS performance data to identify trends, benchmark community performance, and provide actionable recommendations that improve financial results, regulatory compliance, and operational consistency.
• Clinical Documentation Integrity
  • Evaluate and optimize clinical documentation practices to support reimbursement accuracy, reduce risk, strengthen audit readiness, prevent denials, and maximize reimbursement outcomes.
• Partnership with Therapy Services
  • Collaborate with therapy providers to ensure alignment between therapy utilization, documentation practices, and reimbursement requirements.
  • Provide guidance regarding PDPM drivers, clinical coding opportunities, and therapy-related reimbursement processes.
  • Participate in interdisciplinary reviews to ensure appropriate coordination between therapy and nursing documentation.
• Central Billing Office Collaboration
  • Serve as primary clinical liaison to the Central Billing Office.
  • Establish standardized processes that support accurate claim generation and billing compliance.
  • Assist with claim review, reimbursement issue resolution, denial management, and payment optimization.
  • Partner in Triple Check processes and other reimbursement validation procedures.
  • Support reconciliation of MDS, clinical documentation, and billed services.
• Compliance, Auditing and Risk Management
  • Develop an enterprise audit strategy, audit schedules, audit tools and scoring methodology.
  • Conduct periodic audits of revenue integrity, MDS processes, reimbursement practices, and supporting documentation.
  • Identify compliance risks and develop corrective action plans.
  • Lead initiatives to strengthen reimbursement compliance and reduce exposure to denials, take-backs, repayment demands, and survey deficiencies.
  • Ensure adherence to CMS regulations, Medicare guidelines, state requirements, and organizational policies.
• Education and Training
  • Lead enterprise reimbursement education, talent development, and performance improvement initiatives by delivering training and coaching, establishing competency programs and succession pathways, developing reimbursement dashboards and KPI reporting, and driving data-informed operational improvements across the organization.

What You'll Bring To The Team:

• Registered Nurse (RN) license required.
• Bachelor's degree in nursing, Healthcare Administration, Business, or related field required.
• Master's degree preferred.
• Minimum of five (5) years of progressively responsible experience in skilled nursing reimbursement, MDS, PDPM, or post-acute care reimbursement leadership required.
• Multi-site or corporate healthcare experience preferred.
• Demonstrated expertise in Medicare reimbursement methodologies and MDS processes required.
• Experience partnering with billing, clinical operations, nursing leadership, and therapy services required.
• RAC-CT (Resident Assessment Coordinator – Certified), required.
• AAPACN certifications. required
• Other reimbursement, MDS, or long-term care certifications preferred.
• Regional or Corporate leadership experience with multi-facility reimbursement oversight.
• Experience with project leadership, change management, and leadership development preferred.
• Comprehensive knowledge of Medicare, Medicaid, Managed Care, PDPM, and MDS regulations required.
• Strong understanding of skilled nursing clinical operations and documentation requirements required.
• Ability to interpret reimbursement regulations and translate them into operational practices required.
• Strong analytical, auditing, and problem-solving capabilities.
• Exceptional communication, training, and executive reporting skills.
• Ability to lead change and influence interdisciplinary teams across clinical, operational, financial, and executive functions.
• Proficiency with electronic medical records, MDS systems, reimbursement reporting tools, and healthcare billing platforms required.
• Requires ability to drive assigned vehicle(s) or personal vehicle, with appropriate state license, following all laws applicable; must provide proof of liability insurance and must be eligible to be insured under Buckner's insurance Must be age 21 or older to drive on behalf of Buckner.

The above description reflects the details considered necessary to describe the essential functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.