Regional Clinical Reimbursement Specialist-Western and Central MA
$140,000–$140,000 year
On-siteSpringfield, Massachusetts, United States
Job Summary
Conduct regular visits to up to four CareOne facilities in Western and Central Massachusetts to audit Minimum Data Set (MDS) assessments, care plans, and nursing documentation for Medicare, Managed Care, and OBRA compliance. Monitor the Monthly Billing Reconciliation process, facilitate state and federal transmission modifications, and coordinate with facility teams on denial letters and skilled needs. Serve as a resource for center staff regarding PDPM and state Medicaid reimbursement guidelines while ensuring company processes maximize reimbursement. Requires a licensed Registered Nurse with five years of long-term care experience and RAC-CT certification within 90 days. Salary ranges from $140,000 to $155,000 annually.
Required Qualifications
- 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
Desired Qualifications
- 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
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