MDS Auditor

Pavilion Healthcare; Chicago (IL); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Competitive compensation

401(k) with match

Medical insurance (BCBS)

Dental and Vision insurance

Disability insurance

Paid time off

Growth opportunities

Job summary

Pavilion Healthcare is seeking an MDS Auditor to join their team at Pavilion of Logan Square. The MDS Auditor is responsible for the timely review and audit of MDS assessments to ensure compliance with RAI guidelines, regulatory requirements, payer requirements, and organizational policies.

The role focuses on audits across facilities, accuracy of coding, and reporting findings within established timeframes.

Qualifications

• Licensed RN or LPN preferred; associate or bachelor’s degree in Nursing or related field preferred.
• Experience with MDS audits and understanding of RAI Manual requirements is preferred.
• Working knowledge of reimbursement methodologies and CMG components is beneficial.

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 documentation.
• Audit coding accuracy and validate documentation for MDS items impacting reimbursement and quality measures.
• Review CMG components and supporting documentation for accurate reimbursement classification.
• Audit Section GG documentation and coding for consistency with medical records and regulations.
• Review Medicare Part A certifications and recertifications for compliance at a corporate oversight level.
• Verify assessment reference dates, schedules, transmission requirements, and submission timelines.
• Identify discrepancies and communicate findings to facility leadership and corporate compliance leadership.
• Maintain audit logs and supporting documentation per organizational procedures.
• Complete assigned audits within established timelines and productivity expectations.
• Monitor updates to the RAI Manual, MDS requirements, and payer requirements related to audits.
• Conduct trend analysis of audit findings across facilities to identify systemic issues.
• Develop and maintain corporate audit tools and standardized processes.
• Recommend corrective action plans and monitor implementation.
• Participate in corporate compliance, reimbursement, and quality meetings to report audit trends.

Skills

MDS processes

RAI requirements

Section GG coding

attention to detail

data analysis

communication skills

EMR proficiency

time management

data trend analysis

Education

RN/LPN credentials

Nursing degree

Healthcare administration

Health Information Management

Tools

MDS software

EMR software

MS Office

Job description

Pavilion of Logan Square is seeking an MDS Auditor to join their team! The MDSAuditor is responsible for 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. This position conducts routine audits of MDS assessments and supporting documentation to verify accuracy, completeness, coding integrity, and reimbursement-related components. The role is primarily focused on audit completion and reporting of findings within established timeframes.

MDS Auditor Duties and Responsibilities:

• Perform routine audits of MDS assessmentsacross multiple facilities within the organizationfor 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 across facilities.
• Verify that assessment reference dates, assessment schedules, transmission requirements, and submission timelines are met.
• Identify discrepancies, omissions, and documentation trends, and communicate findings tofacility 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 as they relate to audit responsibilities.
• 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.
• All other duties as assigned.

MDS Auditor Skills and Abilities:

• 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.

MDS Auditor Education and Experience:

• 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, all with or without the aid of mechanical devices is required.
• Limited potential for exposure to environmental hazards. Understanding and adherence to company safety standards and protocols required.
• Meet all health requirements as needed.

Dialogue concerning ADA reasonable accommodations are always available upon request – i.e. the interactive process.

Pavilion Healthcare Full-Time 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