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