Clinical Reimbursement Auditing Nurse

Description

Clinical Reimbursement Auditing Nurse – Remote
Full-Time | Remote | Compact Nursing License Required

We are seeking a highly skilled Clinical Reimbursement Auditing Nurse to join our team in a fully remote capacity. The ideal candidate will have strong attention to detail, in-depth knowledge of the Patient-Driven Payment Model (PDPM), and proven experience in conducting Case Mix and accuracy reviews. This role requires an analytical professional who can ensure compliance, optimize reimbursement, and provide expert auditing across multiple states.

Key Responsibilities

• Perform PDPM accuracy and opportunity reviews to ensure compliance and maximize reimbursement.
   
• Conduct Case Mix audits and validate data integrity across multiple facilities.
   
• Analyze MDS submissions for accuracy, consistency, and compliance.
   
• Collaborate with facility staff to provide feedback, education, and recommendations.
   
• Identify trends and assist in developing corrective action plans when necessary.
   
• Maintain up-to-date knowledge of CMS regulations and reimbursement guidelines.
   

Qualifications

• Active Compact RN License required.
   
• Minimum 2 years of MDS/Clinical Reimbursement experience in a skilled nursing facility setting.
   
• Strong working knowledge of PDPM, Case Mix, and Medicare/Medicaid guidelines.
   
• Multi-state reimbursement experience strongly preferred.
   
• Excellent attention to detail, organizational skills, and ability to meet deadlines.
   
• Proficient in electronic medical record (EMR) and MDS software.
   

What We Offer

• Fully remote role with flexible scheduling.
   
• Competitive compensation package.
   
• Opportunities for professional growth and continuing education.
   
• Supportive and collaborative work environment.