Review Choice Demonstration (RCD) Specialist

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

1. Review healthcare claims and supporting documentation to ensure compliance with RCD program standards

2. Analyze medical records for accuracy, completeness, and medical necessity

3. Collaborate with Clinical Managers, Intake, Billing, and Sales teams to resolve documentation issues

4. Provide education and guidance to staff on documentation and RCD compliance requirements

5. Monitor and interpret updates to RCD guidelines, Medicare rules, and relevant coding practices

6. Maintain accurate records of all reviews, findings, trends, and outcomes

7. Identify and analyze patterns in claim submissions to drive process improvements

8. Coordinate interdepartmental review activities for consistent communication and workflow

9. Assist in the creation and delivery of internal training on RCD and documentation standards

10. Stay current on industry best practices through workshops, webinars, and professional development

11. 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