Balance Life & Work with a New Career Opportunity

(LONG TERM CARE)

(SHORT TERM REHAB)

(SKILLED NURSING)

(SUB ACUTE CARE)

NOW HIRING!!  Regional Clinical Reimbursement Specialist Western/Central MA

Salary 

$140,000. - $155,000 annually

Compensation will be based on, but not limited to, experience, qualifications, credentials and any other relevant information

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.

• 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

Position 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 nursing
• 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

Ideal candidates will possess the following:

• Passing RAC-CT certification course within 90 days of employment, paid for by CareOne
• 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