Reimbursement Specialist - Healthcare jobs in Boston, MA

Reimbursement Specialist - Healthcare determines the extent to which patients' insurance covers their treatments. Reviews appropriateness of CPT-4/ICD-10 coding and determines if care provided corresponds to the charges submitted. Being a Reimbursement Specialist - Healthcare ensures compliance with Federal and State regulations and company policies that govern Medicare and state payment systems. May assist in identifying fraudulent non-plan billing practices and assists the legal department with litigation preparation. Additionally, Reimbursement Specialist - Healthcare may require a bachelor's degree. Typically reports to a supervisor or manager. Typically requires Certified Professional Coder (CPC) from AAPC or AHIMA. The Reimbursement Specialist - Healthcare gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Reimbursement Specialist - Healthcare typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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CLINICAL REIMBURSEMENT SPECIALIST/ MULTI FACILITY
  • Personal Healthcare Management LLC
  • Everett, MA FULL_TIME
  • 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.

    IND123

  • 1 Month Ago

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Reimbursement Coordinator
  • Healthcare Support Staffing
  • Woburn, MA FULL_TIME
  • Company DescriptionAre you an experienced Reimbursement Coordinator looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapi...
  • 15 Days Ago

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Clinical Reimbursement Coordinator
  • Genesis HealthCare
  • Wakefield, MA FULL_TIME
  • Sign on Bonus! New Competitive Wages! Genesis is one of the nation's leading providers of healthcare services from short-term to long-term care and a wide variety of living options and professional cl...
  • 7 Days Ago

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Medical Reimbursement Specialist
  • HealthDrive
  • Framingham, MA FULL_TIME
  • Overview HealthDrive delivers on-site dentistry, optometry, podiatry, audiology, behavioral health, and primary care services to residents in long-term care, skilled nursing facilities. Each specialty...
  • 25 Days Ago

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Senior Reimbursement Specialist - Medical Claims
  • HealthDrive
  • Framingham, MA FULL_TIME
  • Overview HealthDrive delivers on-site dentistry, optometry, podiatry, audiology, behavioral health, and primary care services to residents in long-term care, skilled nursing facilities. Each specialty...
  • 23 Days Ago

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Compliance Specialist - Healthcare Setting
  • Jobot
  • Boston, MA FULL_TIME
  • Highly Regarded Boston Health and Social Services Organziation is Hiring a Full-Time Compliance SpecialistThis Jobot Job is hosted by: Joshua TackeAre you a fit? Easy Apply now by clicking the "Quick ...
  • 16 Days Ago

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0 Reimbursement Specialist - Healthcare jobs found in Boston, MA area

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Bilingual Family Intervention Specialist / Social Worker
  • Youth Villages
  • Boston, MA
  • Overview ASK ABOUT OUR $6,000 SIGN-ON PAYMENT Company Overview Youth Villages has been a national leader in the implemen...
  • 3/29/2024 12:00:00 AM

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Regional Clinical Reimbursement Specialist
  • CareOne
  • Millbury, MA
  • Now Hiring - Clinical Reimbursement Specialist - Western MA (Millbury, Redstone and Northampton areas). The Clinical Rei...
  • 3/27/2024 12:00:00 AM

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Registered Nurse - ER/Trauma
  • Advantis Medical Staffing
  • Boston, MA
  • Advantis Medical is seeking an experienced ER/Trauma Registered Nurse for a 11 week travel assignment in Boston, MA! As ...
  • 3/26/2024 12:00:00 AM

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Class A CDL Truck Driver DRY VAN - HIRING IMMEDIATELY Up to $90K!
  • Western Express
  • BOSTON, MA
  • HAVE YOUR CDL-A? SPEAK WITH A SEATING SPECIALIST TODAY! (888) 383-7295 Real Miles. Real Money. Western Express has immed...
  • 3/25/2024 12:00:00 AM

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Reimbursement Specialist
  • Vinfen
  • Cambridge, MA
  • Schedule: Mon-Fri 9am-5pm (2 days remote after training) Salary: $23.00-$25.00 / hour The Reimbursement Specialist is ch...
  • 3/25/2024 12:00:00 AM

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Entry Level Class A CDL Truck Driver - HIRING IMMEDIATELY NO EXPERIENCE!
  • Western Express
  • BOSTON, MA
  • HAVE YOUR CDL-A? SPEAK WITH A SEATING SPECIALIST TODAY! (888) 343-2768 Why wait to earn more? Western Express has immedi...
  • 3/25/2024 12:00:00 AM

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Registered Nurse - ER/Trauma
  • Advantis Medical Staffing
  • Boston, MA
  • Advantis Medical is seeking an experienced ER/Trauma Registered Nurse for a 11 week travel assignment in Boston, MA! As ...
  • 2/29/2024 12:00:00 AM

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Merchandising & Product Demonstration Specialist
  • SAS Retail Services
  • Boston, MA
  • Join our dynamic team as a Merchandising & Product Demonstration Specialist! In this multifaceted role, you'll excel in ...
  • 7/25/2023 12:00:00 AM

Boston has an area of 89.63 square miles (232.1 km2)—48.4 square miles (125.4 km2) (54%) of land and 41.2 square miles (106.7 km2) (46%) of water. The city's official elevation, as measured at Logan International Airport, is 19 ft (5.8 m) above sea level. The highest point in Boston is Bellevue Hill at 330 feet (100 m) above sea level, and the lowest point is at sea level. Situated onshore of the Atlantic Ocean, Boston is the only state capital in the contiguous United States with an oceanic shoreline. Boston is surrounded by the "Greater Boston" region and is contiguously bordered by the citi...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Reimbursement Specialist - Healthcare jobs
$51,045 to $62,025
Boston, Massachusetts area prices
were up 2.5% from a year ago

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