What are the responsibilities and job description for the Review Choice Demonstration (RCD) Specialist position at Senior Care Solutions?
Title: Review Choice Demonstration (RCD) Specialist
Location: Boca Raton, FL
Position Summary
The Review Choice Demonstration (RCD) Specialist plays a critical role in ensuring our agency remains compliant with Medicare's RCD program. Based in Boca Raton, FL, this position serves as the bridge between clinical, intake, billing, and sales teams, reviewing documentation for accuracy, educating staff on compliance requirements, and helping reduce claim denials. If you're detail-oriented, collaborative, and passionate about regulatory excellence in patient care, this role is your opportunity to make a measurable impact in the home health industry.
Essential Duties and Responsibilities
Review healthcare claims and supporting documentation to ensure compliance with RCD program standards
Analyze medical records for accuracy, completeness, and medical necessity
Collaborate with Clinical Managers, Intake, Billing, and Sales teams to resolve documentation issues
Provide education and guidance to staff on documentation and RCD compliance requirements
Monitor and interpret updates to RCD guidelines, Medicare rules, and relevant coding practices
Maintain accurate records of all reviews, findings, trends, and outcomes
Identify and analyze patterns in claim submissions to drive process improvements
Coordinate interdepartmental review activities for consistent communication and workflow
Assist in the creation and delivery of internal training on RCD and documentation standards
Stay current on industry best practices through workshops, webinars, and professional development
Ensure all activities align with agency policies, HIPAA guidelines, and regulatory standards
Relevant healthcare or compliance experience may be considered in place of a formal degree
Strong knowledge of Medicare reimbursement guidelines and RCD program requirements
Expertise in clinical documentation standards and healthcare coding practices
Skilled in reviewing and analyzing medical records and healthcare claims
Familiarity with billing systems and claim workflows in a home health setting
Proficient in ICD-10, CPT, and HCPCS coding systems
Excellent attention to detail and ability to spot inconsistencies
Strong analytical, verbal, and written communication skills
Ability to work independently and manage multiple priorities in a fast-paced environment
Experience with electronic health records and relevant software tools
Background in healthcare auditing or compliance preferred
Physical and Mental Requirements
Must be able to work in a fast-paced and deadline-driven environment
Requires prolonged periods of sitting, reviewing documents, and working on a computer
Occasional travel may be required for meetings or training sessions
Reasonable accommodations will be made for qualified individuals with disabilities
