MDS Auditor

Pavilion of Logan Square is seeking an MDS Auditor to join their team. This role focuses on the timely review and audit of Minimum Data Set (MDS) assessments to ensure compliance with Resident Assessment Instrument (RAI) guidelines, regulatory requirements, payer requirements, and organizational policies.

Responsibilities

• Perform routine audits of MDS assessments across multiple facilities for compliance with RAI guidelines, regulatory requirements, and organizational standards.
• Review MDS assessments for accuracy, completeness, and supporting clinical documentation.
• Audit coding accuracy and validate supporting documentation for MDS items impacting reimbursement and quality measures.
• Review and validate Case Mix Group (CMG) components and supporting documentation to ensure accurate reimbursement classification.
• Audit Section GG documentation and coding to ensure consistency with medical record documentation and regulatory requirements.
• Review Medicare Part A certifications and recertifications for compliance with applicable regulations and organizational standards at a corporate oversight level.
• Verify that assessment reference dates, assessment schedules, transmission requirements, and submission timelines are met.
• Identify discrepancies, omissions, and documentation trends, and communicate findings to facility leadership and corporate compliance leadership.
• Maintain audit logs, records, and supporting documentation in accordance with organizational procedures.
• Complete assigned audits within established timelines and productivity expectations.
• Monitor updates to the RAI Manual, MDS requirements, reimbursement methodologies, and payer requirements.
• Conduct trend analysis of audit findings across facilities to identify systemic documentation, coding, and reimbursement issues.
• Develop and maintain corporate audit tools, templates, and standardized audit processes.
• Recommend corrective action plans and monitor facility-level implementation of audit findings.
• Participate in corporate compliance, reimbursement, and quality meetings to report audit trends and risks.
• Perform all other duties as assigned.

Requirements

• Strong knowledge of MDS assessment processes and RAI requirements.
• Understanding of reimbursement methodologies and case mix classification systems.
• Knowledge of Section GG coding guidelines and documentation requirements.
• Strong attention to detail and accuracy.
• Ability to review large volumes of documentation efficiently and independently.
• Effective written and verbal communication skills.
• Strong organizational and time-management skills.
• Proficiency with electronic medical records, MDS software systems, and Microsoft Office applications.
• Ability to analyze data trends across multiple facilities and identify systemic compliance risks.
• Ability to interpret audit findings and translate them into actionable recommendations.

Qualifications

• Licensed Registered Nurse (RN), Licensed Practical Nurse (LPN), or equivalent healthcare credential preferred.
• Associate's or Bachelor's degree in Nursing, Healthcare Administration, Health Information Management, or related field preferred.
• Working knowledge of MDS 3.0, RAI Manual requirements, reimbursement methodologies, and payer requirements.
• Experience auditing MDS assessments, Section GG documentation, and reimbursement-related components preferred.

Physical Requirements

• Walking, reaching, bending, lifting, extended sitting, grasping, fine hand coordination, pushing, and pulling, with or without mechanical aids.
• Limited potential for exposure to environmental hazards.
• Understanding and adherence to company safety standards and protocols required.
• Must meet all health requirements as needed.

Benefits

• Competitive compensation.
• 401(k) with company match.
• Blue Cross Blue Shield Medical Insurance.
• Dental, Vision, and Disability insurance.
• Generous Paid Time Off.
• Opportunities for growth and advancement.