Regional Clinical Reimbursement Expert

Alliance-Health-; Southborough (MA); On-site; USD 90,000 - 120,000; Full time

Job summary

ALLIANCE HEALTH MANAGEMENT SERVICES in Massachusetts seeks a Regional Clinical Reimbursement Specialist to oversee MDS interviews, ensure CMS-guided care quality, and maintain regulatory compliance for Medicare, Medicaid, and managed care programs. This role coordinates with facility teams and corporate partners to implement plans of care and education.

The position requires nursing licensure in Massachusetts, 2+ years in long-term care, and MDS/RAI experience.

Qualifications

• 2+ years clinical experience in long-term care
• Prior MDS/RAI experience required
• Knowledge of Medicare/Medicaid regulations for skilled nursing

Responsibilities

• Oversee and ensure completion of MDS interviews and assessments per RAI process.
• Assess and evaluate quality of care per CMS guidelines.
• Ensure regulatory compliance with federal and state guidelines for Medicare/Medicaid/Managed Care
• Coordinate with facility and corporate teams to implement plans of care and educate staff
• Provide CR transition training and act as a resource for problem solving

Skills

Clinical experience

MDS/RAI experience

Medicare/Medicaid knowledge

Regulatory compliance

Education

Nursing license MA

Job description

ALLIANCE HEALTH MANAGEMENT SERVICES in Massachusetts seeks a Regional Clinical Reimbursement Specialist to oversee MDS interviews, ensure CMS-guided care quality, and maintain regulatory compliance for Medicare, Medicaid, and managed care programs. This role coordinates with facility teams and corporate partners to implement plans of care and education.

The position requires nursing licensure in Massachusetts, 2+ years in long-term care, and MDS/RAI experience.