MDS Nurse PDPM AUDITOR *MULTI-SITE EXPERIENCE REQUIRED*

The Corporate MDS Nurse PDPM Auditor contributes to the success of the corporate clinical and compliance programs by identifying, address and improving the organization’s coding policies, procedures and internal processes. This will be accomplished by establishing an educational and monitoring protocol that examines how nursing, laboratory and therapy orders are developed, documented and coded in all facilities.

MDS Nurse PDPM Auditor Job duties & responsibilities

• Conduct comprehensive assessments of patient's clinical needs and identify potential PDPM coding opportunities.
• Collaborate with interdisciplinary teams to develop patient-centered care plans that optimize clinical outcomes and maximize reimbursement under PDPM.
• Analyses and organizes PDPM and case mix data to ensure appropriate utilization of resources.
• Review medical documentation to ensure completeness, accuracy, and compliance with CMS regulations.
• Monitor and analyze PDPM-related data, including patient outcomes, revenue, and compliance metrics, and provide regular reports to senior leadership.
• Coordinate with MDS to ensure accurate completion of all MDS assessments and any supporting assessments or clinical documentation.
• Ongoing QA of medical records for the presence of supporting documentation for all items coded on the MDS.
• Provide education and training to staff on PDPM and related topics, including coding, documentation, and care planning
• Participate in quality improvement initiatives to enhance patient care and optimize reimbursement under PDPM.
• Maintain up-to-date knowledge of PDPM regulations and industry best practices and share this information with the facility and management.

MDS Nurse PDPM Auditor Qualifications

• RN / LPN nurse with 3 or more years experience with MDS coding/completion
• Ability to work remotely with minimal supervision
• Multi-facility experience REQUIRED

• Up to date knowledge of Federal Medicare skilling criteria and PDPM reimbursement system/components
• Financial and documentation auditing experience
• Ability to review and analyze data to determine interventions and support required
• Leadership skills
• Teaching/training skills
• Experience with Microsoft Excel, Word, and Office
• Experience with Point Click Care and Optima software helpful
• Ability to follow standard practices in coding & reimbursement.
• Significant exposure to healthcare compliance concepts and compliance auditing.
• Significant experience in Medicaid and Medicare regulatory environment, including experience researching Federal and State coding and billing guidelines and regulations.

MDS Nurse PDPM Auditor Knowledge/Skills/Abilities

• Reimbursement
• Nursing
• MDS