What are the responsibilities and job description for the Clinical Reimbursement Specialist position at CareOne?
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 - Metro Boston/North
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
- 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
- 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
- Comprehensive Healthcare Benefits
- Multiple Medical Plans
- Including Pharmacy
- Including Teladoc
- Multiple Dental Plans
- Vision Plan
- Health Savings Account (eligibility restrictions apply)
- Flexible Spending Accounts
- Voluntary Life and AD&D
- Short-Term and Long-Term Disability Plans
- Hospital Indemnity Insurance
- Critical Illness Insurance
- Accident Insurance
- Whole Life Insurance
- Medicare Employee Assistance
- Legal Plan
- Commuter Benefits
- 401k Retirement Plan
- Employee Assistance Program (available to all employees)
- Paid Time Off
- Vacation
- Sick Plans in accordance with state laws
- Opportunities to advance and grow your career
EEO/AA/M/F/DV
Salary : $155,000