Regional Clinical Reimbursement Specialist

JobID: 20226321 Category: Regional JobSchedule: Posted Date: 2026-03-26T19:29:18+00:00 JobShift: 1st Location Type: Skilled 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 * 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

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