MDS Specialist RN
$83K - $120K/yr
... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...
MDS Specialist RN
$83K - $120K/yr
... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...
MDS Specialist RN
Morristown, NJ · On-site
$83K - $120K/yr
... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...
MDS Specialist RN
Morristown, NJ · On-site
$83K - $120K/yr
... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...
MDS Specialist RN
Morristown, NJ · On-site
$83K - $120K/yr
... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...
MDS Specialist RN
Morristown, NJ · On-site
$83K - $120K/yr
... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...
MDS Specialist RN
Whippany, NJ · On-site
$83K - $120K/yr
... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...
MDS Specialist RN
Whippany, NJ · On-site
$83K - $120K/yr
... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...
MDS Specialist RN
Whippany, NJ · On-site
$83K - $120K/yr
... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...
MDS Specialist RN
Whippany, NJ · On-site
$83K - $120K/yr
... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...
MDS Specialist RN
Whippany, NJ · On-site
$83K - $120K/yr
... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...
MDS Specialist RN
Whippany, NJ · On-site
$83K - $120K/yr
... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...
General Coder - Must have experience doing bill audit reviews
$19.25 - $25.50/hr
... Medicare, Medicare Advantage, and commercial payer audits • Prior demand package review or ... RAC, UPIC, or commercial payer audit response • Multi-state Medicaid policy interpretation • ...
General Coder - Must have experience doing bill audit reviews
$19.25 - $25.50/hr
... Medicare, Medicare Advantage, and commercial payer audits • Prior demand package review or ... RAC, UPIC, or commercial payer audit response • Multi-state Medicaid policy interpretation • ...
RegionalClinical Reimbursement Specialist
Northampton, MA · On-site
$140K - $155K/yr
Audit the completion and accuracy of MDS's and Care Plans per schedule as required for Medicare ... Passing RAC-CT certification course within 90 days of employment, paid for by CareOne * 2-4 Years ...
RegionalClinical Reimbursement Specialist
Northampton, MA · On-site
$140K - $155K/yr
Audit the completion and accuracy of MDS's and Care Plans per schedule as required for Medicare ... Passing RAC-CT certification course within 90 days of employment, paid for by CareOne * 2-4 Years ...
RegionalClinical Reimbursement Specialist
Northampton, MA · On-site
$140K - $155K/yr
Audit the completion and accuracy of MDS's and Care Plans per schedule as required for Medicare ... Passing RAC-CT certification course within 90 days of employment, paid for by CareOne * 2-4 Years ...
RegionalClinical Reimbursement Specialist
Northampton, MA · On-site
$140K - $155K/yr
Audit the completion and accuracy of MDS's and Care Plans per schedule as required for Medicare ... Passing RAC-CT certification course within 90 days of employment, paid for by CareOne * 2-4 Years ...
Regional Clinical Reimbursement Specialist-Western and Central MA
Concord, MA · On-site
$140K - $155K/yr
Audit the completion and accuracy of MDS's and Care Plans per schedule as required for Medicare ... Passing RAC-CT certification course within 90 days of employment, paid for by CareOne * Prior ...
Regional Clinical Reimbursement Specialist-Western and Central MA
Concord, MA · On-site
$140K - $155K/yr
Audit the completion and accuracy of MDS's and Care Plans per schedule as required for Medicare ... Passing RAC-CT certification course within 90 days of employment, paid for by CareOne * Prior ...
Regional Clinical Reimbursement Specialist-Western and Central MA
Concord, MA · On-site
$140K - $155K/yr
Audit the completion and accuracy of MDS's and Care Plans per schedule as required for Medicare ... Passing RAC-CT certification course within 90 days of employment, paid for by CareOne * Prior ...
Regional Clinical Reimbursement Specialist-Western and Central MA
Concord, MA · On-site
$140K - $155K/yr
Audit the completion and accuracy of MDS's and Care Plans per schedule as required for Medicare ... Passing RAC-CT certification course within 90 days of employment, paid for by CareOne * Prior ...
Regional Clinical Reimbursement Specialist-Western and Central MA
Springfield, MA · On-site
$140K - $155K/yr
Audit the completion and accuracy of MDS's and Care Plans per schedule as required for Medicare ... Passing RAC-CT certification course within 90 days of employment, paid for by CareOne * Prior ...
Regional Clinical Reimbursement Specialist-Western and Central MA
Springfield, MA · On-site
$140K - $155K/yr
Audit the completion and accuracy of MDS's and Care Plans per schedule as required for Medicare ... Passing RAC-CT certification course within 90 days of employment, paid for by CareOne * Prior ...
... and audit. * Complete required training and ongoing training to nd maintain system access ... Medicare managed care is preferred. * Assessment-related certification (for example, RAC-CT) is ...
Quick apply
... and audit. * Complete required training and ongoing training to nd maintain system access ... Medicare managed care is preferred. * Assessment-related certification (for example, RAC-CT) is ...
... and audit. * Complete required training and ongoing training to nd maintain system access ... Medicare managed care is preferred. * Assessment-related certification (for example, RAC-CT) is ...
Quick apply
... and audit. * Complete required training and ongoing training to nd maintain system access ... Medicare managed care is preferred. * Assessment-related certification (for example, RAC-CT) is ...
... and audit. * Complete required training and ongoing training to nd maintain system access ... Medicare managed care is preferred. * Assessment-related certification (for example, RAC-CT) is ...
Quick apply
... and audit. * Complete required training and ongoing training to nd maintain system access ... Medicare managed care is preferred. * Assessment-related certification (for example, RAC-CT) is ...
... and audit. * Complete required training and ongoing training to nd maintain system access ... Medicare managed care is preferred. * Assessment-related certification (for example, RAC-CT) is ...
Quick apply
... and audit. * Complete required training and ongoing training to nd maintain system access ... Medicare managed care is preferred. * Assessment-related certification (for example, RAC-CT) is ...
... and audit. * Complete required training and ongoing training to nd maintain system access ... Medicare managed care is preferred. * Assessment-related certification (for example, RAC-CT) is ...
Quick apply
... and audit. * Complete required training and ongoing training to nd maintain system access ... Medicare managed care is preferred. * Assessment-related certification (for example, RAC-CT) is ...
... and audit. * Complete required training and ongoing training to nd maintain system access ... Medicare managed care is preferred. * Assessment-related certification (for example, RAC-CT) is ...
Quick apply
... and audit. * Complete required training and ongoing training to nd maintain system access ... Medicare managed care is preferred. * Assessment-related certification (for example, RAC-CT) is ...
MDS Director - Cura of Le Sueur
Le Sueur, MN · On-site
$37.50 - $47.75/hr
The MDS Director drives appropriate reimbursement (Medicare, Medicaid, and managed care), supports ... Work closely with nursing, therapy (PT/OT/ST), social services, dietary, activities, and physicians ...
Quick apply
MDS Director - Cura of Le Sueur
Le Sueur, MN · On-site
$37.50 - $47.75/hr
The MDS Director drives appropriate reimbursement (Medicare, Medicaid, and managed care), supports ... Work closely with nursing, therapy (PT/OT/ST), social services, dietary, activities, and physicians ...
... and audit. * Complete required training and ongoing training to nd maintain system access ... Medicare managed care is preferred. * Assessment-related certification (for example, RAC-CT) is ...
Quick apply
... and audit. * Complete required training and ongoing training to nd maintain system access ... Medicare managed care is preferred. * Assessment-related certification (for example, RAC-CT) is ...
Part Time Medicare Rac Audit information
What is the difference between Part Time Medicare Rac Audit vs Part Time Medicare Claims Processor?
| Aspect | Part Time Medicare Rac Audit | Part Time Medicare Claims Processor |
|---|---|---|
| Required Credentials | Knowledge of RAC audit procedures, Medicare regulations | Understanding of claims processing, coding, Medicare policies |
| Work Environment | Remote or office-based, audit-focused | Office or remote, claims review and data entry |
| Employer & Industry Usage | Healthcare auditing firms, Medicare contractors | Hospitals, insurance companies, healthcare providers |
While both roles involve Medicare, Part Time Medicare RAC Auditors focus on reviewing and auditing claims for compliance, whereas Part Time Medicare Claims Processors handle the processing and data entry of claims. The roles differ mainly in their focus—auditing versus claims processing—though both require knowledge of Medicare policies and can be performed remotely or in-office.
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$83K - $120K/yr
Full-time, Part-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 7 hours ago
CareOne rating
6.8
Based on 30 frontline employees who took The Breakroom Quiz
49th of 242 rated social care providers
Job description
Balance Life & Work with a New Career Opportunity
SKILLED NURSING
Now Hiring - Lead MDS/Clinical Reimbursement Coordinator - Morristown, NJ
CareOne at Madison
Salary Range $83,000 to $120,000
Lead MDS/Clinical Reimbursement Coordinator will be responsible for, but not limited to:
- MDS/RAI Process Leadership: Direct the timely and accurate completion of the Minimum Data Set (MDS) and Care Area Assessments (CAAs) in strict compliance with CMS regulations.
- PDPM & Reimbursement Strategy: Strategically schedule ARDs and audit clinical documentation to capture true resident acuity, optimizing PDPM components, nursing tiers, and NTA scores.
- Quality Measure & Five-Star Optimization: Analyze Casper reports and partner with the DON/IDT to monitor clinical triggers, drive root-cause corrections, and safeguard the facility's Five-Star rating.
- Interdisciplinary Care Planning: Oversee the development of individualized resident Care Plans that support MDS coding, establish clear goals, and satisfy all regulatory requirements.
- Utilization Review & Triple-Check Coordination: Lead the weekly Utilization Review (UR) and Triple-Check meetings, collaborating with therapy, nursing, and the business office to validate medical necessity, track managed care authorizations, and ensure accurate billing alignment prior to transmission.
- Audit Readiness & Compliance: Systematically audit clinical records (MARs/TARs/physician orders) to defend data integrity against ADRs, MAC/RAC audits, and pre-payment reviews.
- IDT Collaboration & Care Meetings: Facilitate interdisciplinary meetings to ensure seamless care integration and reimbursement alignment.
Position Requirements:
- Licensure: Current, unrestricted Registered Nurse (RN) license in the state of practice.
- MDS Experience: 1-3 years of dedicated MDS experience preferred; or an experienced LTC RN with strong clinical and analytical skills who can be trained.
- Regulatory Expertise: Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term care regulations.
- Clinical Knowledge: Strong understanding of general, rehabilitative, and restorative nursing practices, including comprehensive care planning.
- Software Proficiency: Skilled in Microsoft Windows applications; experience with PointClickCare (PCC) and NetHealth is highly preferred.
- Operational Skills: Exceptional attention to detail with a proven ability to complete assessments accurately and within strict regulatory deadlines.
- Autonomy & Flexibility: Ability to work independently and adjust scheduling to support crucial month-end financial close procedures.
The CareOne mission is to define excellence within the health care community. We are dedicated to Maximizing Patient Outcomes. We 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. We work to maintain the highest standards of care and service for Residents, families and our valued employees.
We are proud to Offer the following benefits to Part-time (22.5+ hours/week) and Full-time Employees:
- Comprehensive Healthcare 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
- 401k 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
If working with people who are dedicated, compassionate, and concerned about their patients is essential to you, then you'll appreciate being a part of our team. We've built a strong reputation on the outstanding level of care that we provide. We have a graciously appointed facility with strong belief in patient care and service; join us at our beautiful facility!
We are an Equal Opportunity Employer
EEO/AA/M/F/DV
About CareOne
Sourced by ZipRecruiter
CareOne is a leading healthcare corporation specializing in senior care, rehabilitation, and assisted living services. Based in Fort Lee, New Jersey, CareOne was established to meet the healthcare requirements of seniors across the state and has expanded its footprint over the years. With its dedication to excellence, CareOne provides a comprehensive range of medical and healthcare services, including post-acute care, long-term and assisted living, memory care, respite care, and more.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Fort Lee, NJ, US
Year founded
1999