Clinical Reimbursement Specialist

CareOne • Concord, MA

2d

About The Position

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 Ideal candidates will possess the following: 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

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

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed