Regional Clinical Reimbursement Specialist

CareOne • Wilmington, MA

5d • $140,000 - $155,000

About The Position

The Regional Clinical Reimbursement Specialist/MDS plays a crucial role in ensuring the accurate and timely completion of the Minimum Data Set (MDS) assessments for residents in long-term care facilities. This position requires a keen understanding of medical records, clinical, documentation, and compliance with healthcare standards. The RCRS will be responsible for regularly visiting up to 3-4 CareOne facilities as assigned based on geography.

Requirements

• Diploma and/or Degree from credentialed school of nursing.
• Currently licensed as a Registered Nurse in the state of practice
• Minimum of 5 years of experience in long term care
• Proven knowledge of quality improvement processes with an emphasis on Medicare, Managed Care and MA Casemix for Skilled Nursing facilities
• Multi facility experience with management skills
• Excellent oral and written communication skills
• Word processing and related computer skills
• Current licensing and credentials are required

Nice To Haves

• 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
• Career Level: Mid Level
• Education Level: Associate degree