• Regional Clinical Reimbursement Specialist

    Job Locations US-MA-New Bedford
    Requisition ID
    CareOne at New Bedford
    Position Category
    Position Type
    Full-Time (37.5+)
  • Overview

    Now Hiring - Regional Clinical Reimbursement Specialist - New Bedford, MA





     CareOne at New Bedford



    The CareOne at New Bedford 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:

    • Competitive Salary
    • Comprehensive Healthcare Benefits
    • 401k Retirement Plan
    • Paid Time Off
    • Opportunities to advance and grow your career
    • And More!

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



    The Regional Clinical Reimbursement Specialist assures the management of the Medicare, Managed Care and Medicaid reimbursement system for a region-specific number of skilled nursing facilities.  Job duties include, but are not limited to:

    • Implement and direct Medicare and Medicaid auditing and systems review.
    • Admission pre-screening review
    • Admission documentation requirement review
    • Financial documentation requirement review
    • Clinical documentation assessment
    • Strategic selection of assessment reference dates
    • MDS accuracy
    • ADL score tracking
    • Denials management
    • RUGs management
    • Provide Interdisciplinary Team Training
    • Consolidated billing
    • Update facilities on trends, developments, concepts and techniques in the Medicaid and Medicare fields that affect reimbursement services
    • Engage facility management team in problem solving process to identify improvement opportunities and achieve solution
    • Facilitate effective, well organized utilization meetings, establish productive objectives and follow through with action plans
    • Evaluate performance of facility-based staff and make recommendations regarding staff assignments, assessment procedure and reimbursement systems.  Ongoing evaluation of the effectiveness of reimbursement staff
    • Fee Schedule


    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




    License Required / Type



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