MDS Auditor - PDPM & Clinical Reimbursement

Job Description

Job Description

MDS Auditor – PDPM & Clinical Reimbursement

Location: Remote
Job Type: Full-Time

Compensation: $90,000-120,000 (DOE/Credentialing)

About the Opportunity

Are you an experienced MDS professional with a strong understanding of PDPM and Medicare reimbursement? We are seeking a knowledgeable MDS Auditor to join our team in a fully remote capacity.

This is an excellent opportunity for an experienced MDS nurse or clinical reimbursement professional looking to utilize their expertise outside of the traditional facility-based MDS role.

In this position, you will play an important role in ensuring accurate MDS assessments, appropriate PDPM classifications, compliant clinical documentation, and reimbursement accuracy across our skilled nursing facilities. You will serve as a resource to facility MDS Coordinators and clinical leadership, helping identify documentation gaps, resolve discrepancies, and promote best practices.

If you enjoy analyzing clinical records, identifying opportunities for documentation improvement, and collaborating with clinical teams, we'd love to hear from you!

What You'll Do

• Review and audit MDS assessments prior to submission to ensure accuracy, completeness, and appropriate PDPM classification.

• Validate ICD-10-CM coding to ensure diagnoses accurately reflect the resident's clinical condition and primary reason for skilled nursing care.

• Review clinical documentation, including nursing notes, physician orders, therapy records, and supporting medical records.

• Evaluate documentation supporting all PDPM reimbursement components, including Nursing, PT, OT, SLP, and Non-Therapy Ancillaries (NTA).

• Identify documentation discrepancies, coding errors, and missing clinical information that could impact reimbursement accuracy.

• Partner with facility MDS Coordinators, Directors of Nursing, and therapy teams to resolve documentation concerns and address audit findings.

• Conduct routine clinical reimbursement audits to ensure compliance with Medicare guidelines and applicable state and federal regulations.

• Provide actionable feedback, education, and recommendations to facility teams regarding MDS accuracy, PDPM requirements, and clinical documentation best practices.

• Monitor changes to Medicare reimbursement regulations and MDS requirements and communicate relevant updates to clinical teams.

What We're Looking For

• Active RN, LPN, PT, OT, or SLP license.

• Minimum of 1 year of MDS coordination or clinical reimbursement experience.

• Strong working knowledge of Medicare PDPM guidelines and MDS assessment requirements.

• Experience reviewing MDS assessments, ICD-10-CM coding, and supporting clinical documentation.

• Understanding of Medicare reimbursement requirements and skilled nursing facility regulations.

• Strong analytical, organizational, and problem-solving skills with exceptional attention to detail.

• Ability to work independently while collaborating with multiple facility teams.

• Proficiency with PointClickCare, MatrixCare, or other skilled nursing EHR systems.

Preferred Qualifications:

• RAC-CT certification or equivalent MDS credential.

• Previous experience in PDPM auditing, reimbursement review, or MDS consulting.

• Experience providing regional or corporate MDS support.

• Advanced knowledge of ICD-10-CM coding and PDPM classification methodology.

What We Offer

• Fully remote work opportunity.

• Competitive salary based on experience.

• Comprehensive benefits package.

• Continuing education and professional development support.

• Opportunity to utilize your MDS and reimbursement expertise in a centralized clinical support role.

• Collaborative team environment.

Bring your MDS and PDPM expertise to a role where you can make a meaningful impact across multiple skilled nursing facilities. Enjoy the opportunity to step beyond traditional facility-based MDS coordination while helping support clinical accuracy, Medicare compliance, and reimbursement integrity.

 

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