Reimbursement Specialist - Healthcare jobs in Massachusetts

CLINICAL REIMBURSEMENT SPECIALIST/ MULTI FACILITY

We offer competitive compensation and benefit plans including:

• Competitive Pay
• Medical, Dental, Vision Insurance
• Generous PTO
• Life and Disability insurance
• 401k
• Great Benefits Package
• Fun, Family-Like Team, and Atmosphere!

We are seeking an experienced Clinical Reimbursement Specialist to support our MDS/MMQ teams in Massachusetts. The Clinical Reimbursement Specialist will work under the direction of the Corporate Director of Clinical Operations- MA division. 

The Clinical Reimbursement Specialist provides extensive training, analysis, advice and consultation to the facilities and teams within his/her area of responsibility. Ensures compliance with federal and state regulations, MA Medicaid, Medicare and Managed Care payment systems. Monitors, consults, and makes effective recommendations for changes and modifications to existing facility processes, systems, policies, and practices which will assure efficient, effective, and compliant state Medicaid/Medicare/Managed Care payment performance.

ESSENTIAL DUTIES & RESPONSIBILITIES

Job Functions include but are not limited to:

• Provides consultation, training and support concerning the MA Medicaid, Medicare, Managed Care, and state case mix payment system for the assigned area.
• Analyzes systems and processes to determine that federal and state regulations as well as company policies and procedures are followed. Supporting documentation, and other relevant data.
• Responsible for overseeing and completing MA MMQs in (2- 3) MA Facilities, PDPM and MDS OBRA completion as needed, responsible for compliance and reimbursement maximization. 
• Studies, analyze and reports period over period information and systems in order to identify trends and deviations from results in Medicare and takes appropriate actions.
• Works in conjunction with teams to resolve issues effecting deviations from expected results. Recommends changes and performs follow-up to ensure that those recommendations are effectively implemented and monitored for appropriateness.
• Regularly communicates to management outside the facility on recommendations made to facility management to ensure proper implementation and follow-up.
• Assists in the recruitment/interview process for MDS and MMQ vacancies.

Qualifications:

• Licensed as a Registered Nurse in the State of Massachusetts
• Three to Five years of clinical experience in a long-term care setting, which includes supervisory, administrative, or consultative capacities.
• Current knowledge of computer technology and systems.
• Ability to work independently with minimal supervision and guidance.
• Extensive knowledge/ experience in MMQ, MDS and back-up documentation required and extensive knowledge of state grouper and calculator field relative to MDS and MA Medicaid payment methodology.
• Extensive knowledge of Medicare reimbursement, compliance, and eligibility.

Knowledge, Skills, and Abilities

• Proficiency with Microsoft Outlook, Microsoft Office, Word, Excel, Power Point
• Strong organizational skills and interpersonal skills
• Demonstrated knowledge (Medicaid, Medicare) and case management process (prior authorization and appeals) required
• Ability to multi-task and adapt to changing priorities
• Ability to effectively communicate verbally and in writing
• Customer focused, demonstrated ability to interact with customers, management, and establish strong working relationships
• Ability to work independently and as a team member
• Ability to problem solve

Covid 19 Vaccine: Required

Job Type: Full-time

ACKNOWLEDGEMENT

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. All pay rates and bonuses are paid and/ or awarded to employees based on the facilities policy and/ or the CBA, depending on the position.

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