Krystal Wheless
Timpson,TX
Summary
Director of Clinical Reimbursement recognized for orchestrating teams and advancing compliance initiatives. Achieved minimal recoupment amounts through strategic OIG reviews and extensive MDS training programs, upholding high standards across multiple facilities.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Regional Reimbursement Consultant
Avir Health Group
08.2025 - Current
- Monitored RAI processes and compliance across 12 skilled nursing facilities.
- Conducted facility audits to enhance reimbursement and ensure MDS accuracy.
- Trained MDS Coordinators, elevating operational standards significantly.
- Ensured timely LTCMI submissions, preventing PCE occurrences.
- Oversaw PASRR processes, including PE, PCSP, and NFSS assessments.
- Conducted mock surveys to identify improvement opportunities.
- Reviewed referrals for medical necessity, ensuring accurate billing.
Director of Clinical Reimbursement
Summit LTC Management
Fort Worth, Texas
03.2023 - 07.2025
- Supervised three Regional Reimbursement Consultants and 18 MDS Coordinators organization-wide.
- Facilitated QIPP program education through weekly calls and detailed workbook reviews.
- Monitored Quality Measures, providing necessary educational resources.
- Led OIG reviews, achieving minimal recoupment amounts across the organization.
- Delivered annual training on MDS updates, including PDPM LTC, for MDS Coordinators and RRC.
- Participated in mock surveys to assess compliance and readiness effectively.
- Collaborated with Accounts Receivable to resolve unbillable issues across 18 facilities.
- Coordinated documentation completion for MDS assessments alongside clinical teams.
Regional Reimbursement Consultant
Summit LTC Management
Fort Worth, Texas
05.2020 - 03.2025
- Monitored RAI processes and compliance for six skilled nursing facilities.
- Conducted PASRR, NFSS, PCSP, and PE monitoring to ensure adherence to regulatory standards.
- Managed LTCMI submissions while executing ongoing monitoring activities efficiently.
- Educated interdisciplinary teams on MDS processes to improve care planning accuracy.
- Participated in mock surveys and attended annual recertifications for all six facilities.
- Filled MDS vacancies to maintain operational continuity across the region.
- Collaborated with BOM to facilitate PCPM, LOC, and Triple Check meetings with MDS Coordinator.
MDS Coordinator
Summit Nursing and Rehabilitation
San Augustine, TX
02.2017 - 04.2020
- Coordinated MDS assessments for residents to ensure compliance with regulations.
- Implemented care plans based on MDS data and interdisciplinary team input.
- Trained staff on MDS documentation and regulatory requirements to improve accuracy.
- Reviewed resident charts for completeness and accuracy in MDS submissions.
- Facilitated communication between departments regarding resident needs and care plans.
- Analyzed MDS data for trends to support quality improvement initiatives.
- Facilitated team meetings with members from other departments such as Social Services, Dietary, Activities, Rehabilitation services, to discuss resident issues and concerns related to the MDS process.
- Monitored residents' progress and updated MDS records accordingly.
- Participated in survey preparation activities by ensuring that all necessary documents were available during surveys conducted by state agencies or accreditation organizations.
Regional Reimbursement Consultant
Daybreak VentureLLC
07.2015 - 02.2017
- Collaborated with MDS Coordinators to ensure RAI compliance and MDS accuracy.
- Provided training on MDS protocols and procedures.
- Facilitated LTCMI submissions to meet regulatory requirements.
- Managed PASRR processes to enhance operational efficiency.
- Conducted facility audits and visits to optimize reimbursement and verify MDS accuracy.
Education
LVN -
Panola College
Carthage, TX12-2006
Skills
- RAI compliance and MDS assessment
- Regulatory audits and LTCMI submissions
- Documentation management
- Quality improvement
Certification
- CPR
- CPR Instructor
Timeline
Regional Reimbursement Consultant
Avir Health Group
08.2025 - Current
Director of Clinical Reimbursement
Summit LTC Management
03.2023 - 07.2025
Regional Reimbursement Consultant
Summit LTC Management
05.2020 - 03.2025
MDS Coordinator
Summit Nursing and Rehabilitation
02.2017 - 04.2020
Regional Reimbursement Consultant
Daybreak VentureLLC
07.2015 - 02.2017
LVN -
Panola College
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