• Clinical Reimbursement Specialist

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

    Looking for your next opportunity? If so, choose CareOne Management and discover what a meaningful job feels like while you help us restructure our Clinical Reimbursement Department.  Whether you work directly with patients or use your talent to support our care, you’ll be part of a team that’s providing valuable health services.  Here you’ll have the opportunity to put your skills to work, and the support to grow and advance in your job and your field.  Step into a career that will make a substantial difference for our patients-and for you.


    Make sure your career is in the right place at the right time – Join CareOne at Peabody Today!


    The Clinical Reimbursement Specialist/MDS Coordinator provide guidance and oversight to assessment coordinators related to the MDS and subsequent reimbursement processes for accuracy in assessment completion and maximization of reimbursement through PPS, case mix or MMQ (if applicable).


    The Clinical Reimbursement Specialist/MDS Coordinator ensures RAI guidelines are followed in the assigned region with a focus on resident care and maximizing financial reimbursement through the MDS process.


    • Review of MDS assessments on a minimum of a quarterly basis including; quarterlies, annuals, significant changes and admission assessments to ensure scheduling and completion are in compliance with the RAI process and any related state and/or federal regulations to include CAA’s and the care planning process.
    • Quarterly review of admissions/discharges to ensure discharge and/or re-entry assessments are present and dated appropriately.
    • Review of Medicare PPS assessments on a minimum of a quarterly basis including dually coded full assessments to ensure accurate coding on all sections of the MDS with supportive documentation present to maximize financial reimbursement.
    • Review of Medicare assessment scheduling on a monthly basis including unscheduled OMRA assessments
    • Monthly review of skilled certifications/re-certifications to ensure appropriate documentation is present and signed by licensed professional in accordance with federal and/or state regulations.
    • Monthly review of each facility RUG report to review distribution and monitor for any trends including fluctuations in ADL scoring or associated end split.
    • Review of case mix on a quarterly basis to ensure accuracy. (if applicable)
    • Active participation in documentation review in preparation for reporting in the MMQ process (MA only)
    • Assist facility in orientation of MDS Coordinator when a vacancy is filled.
    • Provide mentoring and guidance to assessment offices as needed during on-site visits as well as via email and telephone.
    • Completion of a center visit report on a minimum of a monthly basis to include findings and corresponding PI plan if indicated.
    • Other duties as assigned.


    • Minimum of 5 years as an active Registered Nurse
    • A minimum of 3 years in long term care with MDS experience required
    • Extensive knowledge of the RAI process and reimbursement requirements for both federal and state
    • BSN preferred, RAC-CT certification or within 6 months of hire date
    • Actively licensed driver in good standing with reliable mode of transportation
    • Highly organized, ability to multi-task throughout the day
    • Ability to troubleshoot problems/questions from facilities off-site
    • Experience in a multi-facility organization preferred
    • Good communication skills, ability to interact with facility and regional staff appropriately
    • Experience with Microsoft Power point, Word, Outlook
    • Experience in developing templates to utilize in facility for audit and/or educational sessions           





    License Required / Type



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