Skilled Systems Specialist
Core
Support MDS and reimbursement processes through clinical technology management, audits, and data validation for skilled nursing facilities.
Role type
Skilled Systems Specialist (MDS & Reimbursement)
Builds
Clinical documentation accuracy and CMS compliance for SNF/LTC operations
Domain
Healthcare Administration / Skilled Nursing / Long-Term Care
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
MDS coding, Medicare reimbursement knowledge, EHR systems (PointClickCare), auditing, training capability, data validation, CMS regulatory compliance
Preferred skills
MDS certification (RAC-CT), Healthcare Administration or Nursing background, SNF/LTC operations experience
Technologies
PointClickCare (PCC), Net Health, PointRight, CMS reporting tools (CASPER, Roster)
Responsibilities
Establish partnerships with operations and clinical leadership for MDS processes; Promote effective use of clinical technologies including PointClickCare; Provide end-user support and training for clinical systems; Conduct routine audits of OBRA and PPS assessments; Perform random audits of MDS assessments to validate accuracy; Review Medical Review packages prior to submission; Support ADRs, denials, and appeal processes; Monitor CMS QRP Preview Reports and VBP performance indicators; Review validation warnings/errors and confirm corrective action; Develop reports to track clinical, regulatory, and reimbursement metrics
Seniority
Mid-level, hands-on IC
