CareOne
Clinical Reimbursement Coordinator – Livingston, NJ
Salary Range: 76k-120k
The Clinical Reimbursement Coordinator assures the implementation of company policies and procedures pertaining to Medicare and managed‑care reimbursement in the facility. This position reports to the Administrator of the facility and receives consultative assistance from the Regional Clinical Reimbursement Specialist. The Coordinator is also responsible for regulatory compliance and quality‑improvement efforts in order to attain appropriate Medicare or managed‑care reimbursement. The role integrates information from all necessary disciplines to maintain accuracy and compliance with the MDS process. By conducting concurrent MDS reviews, the Coordinator ensures the achievement of maximum allowable RUG categories. Working collaboratively with facility team members, the Coordinator ensures that services offered meet or exceed federal, state and company standards and serves as a role model for ethical business practices.
Essential Duties and Responsibilities
Maintain a professional standard of behavior when interacting with staff, resident family members or visitors
Follow and uphold the company Code of Conduct
Facilitate daily PPS and weekly Medicare meetings
Knowledge of and compliance with HIPAA guidelines
Knowledge of and ability to download reports from Point Right
Knowledge of and ability to download state and federal reports from the internet
Participate in monthly billing reconciliation meetings
Complete MDS reports per schedule as required for Medicare, managed‑care and OBRA schedules
Initiate/update care plans as required
Ensure compliance with state, federal, and Point Right transmissions and make modifications as needed
Facilitate and coordinate with other disciplines to maintain care‑plan development and ongoing updates per MDS schedule
Provide updates as required per managed‑care contract guidelines
Communicate promptly with facility team/regional consultant any issues or concerns
Completion and issuance of denial letters, coordination of Medicare certification completion, review of skilled nursing documentation (including CNA documentation) to support skilled needs
Serve as the central resource for MDS/PPS and state Medicaid reimbursement
Manage Medicare appeals process and participate in Administrative Law Judge hearings as needed
Implement and participate in company processes developed to appropriately maximize reimbursement
Position Requirements
Graduate of an approved RN program
Current RN license in the state and credentials as required
Prior experience in Medicare reimbursement and/or MDS experience preferred
Knowledge of managed‑care reimbursement systems
Word‑processing and computer skills
Excellent oral and written communication skills
Excellent ability to maintain an effective, friendly working relationship with others
Basic mathematical ability; ability to use a calculator
Knowledge of quality‑improvement process, how it affects the 5‑Star report, and ability to identify issues or trends and implement corrective‑action plans as needed
Knowledge of the 5‑Star report
Excellent attention to detail; well organized
Ability to provide one‑on‑one or small‑group education related to identified areas of need
Benefits We are proud to offer the following benefits to part‑time (22.5+ hours/week) and full‑time employees:
Comprehensive Health Care Benefits
Multiple Medical Plans
Including Pharmacy
Including Teladoc
Multiple Dental Plans
Vision Plan
Health Savings Account (eligibility restrictions apply)
Flexible Spending Accounts
Voluntary Life and AD&D
Short‑Term and Long‑Term Disability Plans
Hospital Indemnity Insurance
Critical Illness Insurance
Accident Insurance
Whole Life Insurance
Medicare Employee Assistance
Legal Plan
Commuter Benefits
401(k) Retirement Plan
Employee Assistance Program (available to all employees)
Paid Time Off
Vacation
Sick Plans in accordance with state laws
Opportunities to advance and grow your career
About Us The CareOne mission is to define excellence within the health care community. We are dedicated to maximizing patient outcomes and 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, maintaining the highest standards of care and service.
We are an Equal Opportunity Employer. EEO/AA/M/F/DV
#J-18808-Ljbffr
The Clinical Reimbursement Coordinator assures the implementation of company policies and procedures pertaining to Medicare and managed‑care reimbursement in the facility. This position reports to the Administrator of the facility and receives consultative assistance from the Regional Clinical Reimbursement Specialist. The Coordinator is also responsible for regulatory compliance and quality‑improvement efforts in order to attain appropriate Medicare or managed‑care reimbursement. The role integrates information from all necessary disciplines to maintain accuracy and compliance with the MDS process. By conducting concurrent MDS reviews, the Coordinator ensures the achievement of maximum allowable RUG categories. Working collaboratively with facility team members, the Coordinator ensures that services offered meet or exceed federal, state and company standards and serves as a role model for ethical business practices.
Essential Duties and Responsibilities
Maintain a professional standard of behavior when interacting with staff, resident family members or visitors
Follow and uphold the company Code of Conduct
Facilitate daily PPS and weekly Medicare meetings
Knowledge of and compliance with HIPAA guidelines
Knowledge of and ability to download reports from Point Right
Knowledge of and ability to download state and federal reports from the internet
Participate in monthly billing reconciliation meetings
Complete MDS reports per schedule as required for Medicare, managed‑care and OBRA schedules
Initiate/update care plans as required
Ensure compliance with state, federal, and Point Right transmissions and make modifications as needed
Facilitate and coordinate with other disciplines to maintain care‑plan development and ongoing updates per MDS schedule
Provide updates as required per managed‑care contract guidelines
Communicate promptly with facility team/regional consultant any issues or concerns
Completion and issuance of denial letters, coordination of Medicare certification completion, review of skilled nursing documentation (including CNA documentation) to support skilled needs
Serve as the central resource for MDS/PPS and state Medicaid reimbursement
Manage Medicare appeals process and participate in Administrative Law Judge hearings as needed
Implement and participate in company processes developed to appropriately maximize reimbursement
Position Requirements
Graduate of an approved RN program
Current RN license in the state and credentials as required
Prior experience in Medicare reimbursement and/or MDS experience preferred
Knowledge of managed‑care reimbursement systems
Word‑processing and computer skills
Excellent oral and written communication skills
Excellent ability to maintain an effective, friendly working relationship with others
Basic mathematical ability; ability to use a calculator
Knowledge of quality‑improvement process, how it affects the 5‑Star report, and ability to identify issues or trends and implement corrective‑action plans as needed
Knowledge of the 5‑Star report
Excellent attention to detail; well organized
Ability to provide one‑on‑one or small‑group education related to identified areas of need
Benefits We are proud to offer the following benefits to part‑time (22.5+ hours/week) and full‑time employees:
Comprehensive Health Care Benefits
Multiple Medical Plans
Including Pharmacy
Including Teladoc
Multiple Dental Plans
Vision Plan
Health Savings Account (eligibility restrictions apply)
Flexible Spending Accounts
Voluntary Life and AD&D
Short‑Term and Long‑Term Disability Plans
Hospital Indemnity Insurance
Critical Illness Insurance
Accident Insurance
Whole Life Insurance
Medicare Employee Assistance
Legal Plan
Commuter Benefits
401(k) Retirement Plan
Employee Assistance Program (available to all employees)
Paid Time Off
Vacation
Sick Plans in accordance with state laws
Opportunities to advance and grow your career
About Us The CareOne mission is to define excellence within the health care community. We are dedicated to maximizing patient outcomes and 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, maintaining the highest standards of care and service.
We are an Equal Opportunity Employer. EEO/AA/M/F/DV
#J-18808-Ljbffr