About the job
CareOne invites you to explore an exceptional opportunity as a Metro Boston Regional Reimbursement Specialist. This position offers a hybrid/remote work arrangement, requiring 3 days of fieldwork/building visits and 2 days of remote office work.
We are seeking a candidate with regional experience; however, we are also open to a motivated and goal-oriented MDS Coordinator with a minimum of 4 years of experience.
This role encompasses the following CareOne centers:
- Newton MA
- Brookline MA
- Lexington MA
- Concord MA
The RCRS will report directly to the Senior VP of Clinical Reimbursement.
Key Responsibilities:
- Uphold professional behavior standards.
- Follow and adhere to the company Code of Conduct.
- Comply with HIPAA regulations.
- Participate in PDPM and Weekly Medicare meetings during center visits.
- Oversee compliance with the Monthly Billing Reconciliation process.
- Audit the accuracy and completion of MDS and Care Plans as per Medicare, Managed Care, and OBRA schedules.
- Ensure compliance with state, federal, and SimpleLTC transmissions, implementing modifications as necessary.
- Collaborate with regional staff for necessary coordination.
- Communicate any issues or concerns promptly to your supervisor and facility/regional team.
- Monitor and audit denial letter issuance and coordinate Medicare certification completion, ensuring nursing documentation supports skilled needs.
- Serve as a resource for center staff regarding PDPM and state Medicaid reimbursement guidelines.
- Ensure adherence to company processes designed to maximize reimbursement effectively.

