Reimbursement Specialist - Healthcare jobs in Worcester, MA

Alliance Health Management Services is looking for an experienced clinical reimbursement specialist to join our regional team.  In this role you will support our 8 facilities with any and all clinical reimbursement needs. Including:

• Review the current AHMS Clinical Reimbursement (CR) Policies and Procedures for respective area, recommend modifications.
• Determine compliance with established policy. Develop and utilize a facility reporting process to ensure facility compliance with established policies.  This includes both remote monitoring and onsite audits.
• Evaluate current clinical reimbursement documentation forms and assessments to ensure facilities capture the care provided and maximize reimbursement.
• Provide CR transition training to the organization to ensure that trainees gain functional knowledge, and the organization is prepared for the transition.
• Serve as a resource to CR staff for problem solving and real time education as needed for respective area.
• Ensure that all submissions are accurate, timely, and fully compliant with current rules and regulations.
• Review and assist in all ARD requests from third party payers.
• Conduct onsite audits and reviews of entire CR process. Conduct exit review with facility staff with findings and clear objectives.
• Review and audit PASRR/NOMNC submissions.
• Assist facilities with QM ratings objectives.

We are a not-for-profit organization and we welcome your experience, skills, and professionalism as we improve the lives or our ressidents.  

Benefits:

· 401(k)

· 401(k) matching

· Dental insurance

· Health insurance

· Life insurance

· Paid time off

· Professional development assistance

· Referral program

· Tuition reimbursement

· Vision insurance

- Employee Assistance Program

- Travel Expenses

Requirements:

2 Years expereince

Bachelor Degree Required

RN License Required 

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