Temp Part-time, Skilled Nursing Facility – Patient-Driven Payment Model

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct quality assessments of finalized SNF/PDPM audits to confirm coding precision, reimbursement decisions, supporting documentation, and audit justification.

• Ensure that audit outcomes comply with CMS guidelines, RAI Manual standards, PDPM regulations, client specifications, and departmental protocols.

• Clearly and accurately document findings from quality reviews.

• Recognize quality patterns, recurring audit mistakes, and potential areas for process enhancement.

• Provide constructive, written feedback to auditors.

• Meet productivity and quality targets.

• Respond promptly to emails and meeting requests, and attend scheduled meetings.

• Engage in discussions and team meetings, offering suggestions for improvement or volunteering when necessary.

• Comply with EXL Health policies and procedures.

• Report any audit or quality-process issues to the Quality Manager for resolution.

• Identify and communicate facility- and provider-specific challenges impacting audits.

• Stay informed about CMS regulations, PDPM reimbursement methods, MDS 3.0 requirements, and industry best practices.

• Track regulatory changes that influence SNF/PDPM auditing processes.

⛳️ Requirements

• Active Registered Nurse, Licensed Practical Nurse, or Licensed Vocational Nurse license in good standing in your residing state.

• At least 5 years of experience in SNF clinical settings, MDS 3.0 completion, PDPM reimbursement methods, quality assurance, auditing, or related fields.

• In-depth knowledge of MDS 3.0 coding guidelines, levels of care in skilled nursing facilities (SNF), and PDPM reimbursement.

• Prior experience or exposure to the billing processes of HIPPS codes.

• Experience in reviewing audit results, conducting quality revisions, or performing compliance monitoring tasks.

• Proficient in Excel, PowerPoint, Outlook, and Word.

• Familiarity with Encoder tools such as 3M.

• Expertise in Medicare Local Coverage Determinations (LCD) and National Coverage Determinations (NCD).

• Must possess strong attention to detail.

• Excellent verbal and written communication skills are required.

• Must be self-motivated and capable of working with minimal supervision.

🏝️ Benefits

• Flexibility to work remotely.

• Up to 10% annual travel for team meetings and occasional client onsite engagements.

• Opportunities for professional growth and mentorship through a structured coaching program.

• A collaborative culture that values ideas and insights.

• Opportunities for career advancement.

• A fast-paced, innovative environment with a team of dedicated professionals.