Regional Clinical Reimbursement Specialist

About the role

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.

Responsibilities

• Regularly visit 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.

Requirements

• Diploma and/or Degree from a 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.

Qualifications

• 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.

Skills

• Passing RAC-CT certification course within 90 days of employment, paid for by CareOne.
• Excellent ability to work collaboratively with a cross functional healthcare team.
• Basic knowledge of Quality Measures.
• Knowledge of the 5 Star report.

Benefits

• Comprehensive Healthcare Benefits.
• Multiple Medical Plans Including Pharmacy.
• 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 OffVacationSick Plans in accordance with state laws.

Pay

Salary: $140,000. - $155,000 annually. Compensation will be based on, but not limited to, experience, qualifications, credentials and any other relevant information.

Schedule

Part-time (22.5+ hours/week) and Full-time Employees.