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Clinical Reimbursement Specialist

CareOne Management LLC

Millbury, MA

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JOB DETAILS
SALARY
SKILLS
Accidental Death and Dismemberment (AD&D), Acute Care, Billing, Calendar Management, Clinical Study Publications, Communication Skills, Computer Skills, Corporate Compliance, Cross-Functional, Dental Insurance, Facilities Management, Flexible Spending Accounts, Geography, Health Plan, Healthcare, Healthcare Reimbursement, Legal, Licensing, Long-Term Care, Maintain Compliance, Managed Care, Medicaid, Medical Records, Medicare, Medicare Reimbursement, Minimum Data Set, Nursing, Nursing Credentials, Pharmacy, Presentation/Verbal Skills, Process Development, Quality Management, Quality Metrics, Quality of Care, Reconciliation, Registered Nurse (RN), Regulatory Compliance, Reimbursement, Reimbursement Guidelines, Standards of Care, State Laws and Regulations, Support Documentation, Team Player, Time Management, Vision Plan, Word Processing, Writing Skills
LOCATION
Millbury, MA
POSTED
30+ days ago

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 MDSs 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.

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.

We are proud to Offer the following benefits to Part-time (22.5+ hours/week) and Full-time Employees:

  • 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

If working with people who are dedicated, compassionate, and concerned about their patients is essential to you, then youll appreciate being a part of our team. Weve 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

About the Company

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CareOne Management LLC