Clinical Reimbursement Specialist

CareOne Group•Holyoke, MA

About The Position

The CareOne mission is to define excellence within the health care community. We are dedicated to Maximizing Patient Outcomes. We treat Residents, their families and each other with respect, dignity and compassion. Through a collaborative and consultative approach, we strive to provide a framework of strength and stability for our Centers and Communities. We work to maintain the highest standards of care and service for Residents, families and our valued employees. If working with people who are dedicated, compassionate, and concerned about their patients is essential to you, then you'll appreciate being a part of our team. We've built a strong reputation on the outstanding level of care that we provide. We have a graciously appointed facility with strong belief in patient care and service; join us at our beautiful facility! We are an Equal Opportunity Employer EEO/AA/M/F/DV

Requirements

Passing RAC-CT certification course within 90 days of employment, paid for by CareOne
2-4 Years' Prior experience in Medicare PDPM Reimbursement and/or MDS experience
General knowledge of Managed Care reimbursement systems
Excellent ability to work collaboratively with a cross functional healthcare team
Basic knowledge of Quality Measures
Knowledge of the 5 Star report

Responsibilities

Monitor compliance with the Monthly Billing Reconciliation process
Audit the completion and accuracy of MDS's and Care Plans per schedule as required for Medicare, Managed care and OBRA schedules
Ensure compliance with State, Federal, and SimpleLTC transmissions and facilitate modifications as needed
Facilitate and coordinate with other regional staff as needed
Communicate promptly to your supervisor and facility team/regional team any issues or concerns
Monitor/Audit the issuance of denial letters, coordination of Medicare certification completion, and nursing documentation to support skilled needs
Serve as a resource for the center staff for PDPM and state Medicaid reimbursement guidelines
Monitor the compliance of company processes developed to appropriately maximize reimbursement