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Genesis HealthCare

Maintains accurate third party payer reimbursement modeling and contract maintenance systems. Verifies reporting from such systems in order to provide accurate, high quality information pertaining to ...

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How much do reimbursement consultant jobs pay per year?

As of Aug 7, 2026, the average yearly pay for reimbursement consultant in the United States is $94,999.00, according to ZipRecruiter salary data. Most workers in this role earn between $92,500.00 and $97,500.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a reimbursement consultant?

To excel as a Reimbursement Consultant, a solid background in healthcare reimbursement processes, knowledge of payer guidelines, and a relevant bachelor's degree (such as in healthcare administration, nursing, or business) are essential. Familiarity with coding systems (ICD-10, CPT), claims management software, and sometimes certifications like Certified Professional Coder (CPC) or Certified Professional Biller (CPB) are commonly required. Exceptional analytical skills, attention to detail, and strong communication abilities are vital for success in this role. These competencies ensure accurate reimbursement, effective negotiation with payers, and optimal support for healthcare providers in a complex regulatory environment.

What does a reimbursement consultant do?

A Reimbursement Consultant helps healthcare organizations navigate insurance reimbursement processes, ensuring they receive proper payment for services. They analyze billing procedures, verify compliance with regulations, and assist in resolving denied claims. Their role may include advising on coding practices, negotiating with payers, and optimizing revenue cycle management. By staying up to date with changing healthcare policies, they help organizations maximize reimbursements and minimize financial risks.

What are some typical challenges faced by reimbursement consultants, and how are they addressed?

Reimbursement Consultants often deal with navigating complex payer policies, staying current with rapidly changing healthcare regulations, and resolving denied or underpaid claims. These challenges require consistent attention to detail and the ability to analyze and interpret different reimbursement guidelines. Strong collaboration with billing teams, payers, and healthcare providers helps consultants address these issues efficiently. Additionally, successful consultants prioritize ongoing education to stay informed about regulatory updates and industry best practices, ensuring compliance and optimal reimbursement outcomes.

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Reimbursement Consultant jobs near you
Infographic showing various Reimbursement Consultant job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 71% Full Time, 18% Part Time, and 10% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $94,999 per year, or $45.7 per hour.

Regional Clinical Reimbursement Consultant - State Veterans Homes

STG International, Inc.

Asheville, NC • On-site

Full-time

Re-posted 29 days ago

Job description

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 (RCRC) 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 extensive 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 


Required Skills

REQUIRED EXPERIENCE AND SKILLS: 

Required 

    STG International logo

    About STG International

    Sourced by ZipRecruiter

    STG International is a leading organization in the field of Professional Services, providing a wide variety of solutions in healthcare staffing, executive level personnel, technical expertise and project management among others. The company, which began operations in 1997, is headquartered in Arlington, Virginia. STG International is underpinned by a strong mission to provide the highest quality of professional services to meet the evolving needs of its clientele in both public and private sectors, uniquely coupling innovative solutions with a client-focused approach.

    Industry

    Hospitals

    Company size

    1,001 - 5,000 Employees

    Headquarters location

    Arlington, VA, US

    Year founded

    1997

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