MDS Auditor - Compliance & Reimbursement Lead

Pavilion of Logan Square; Chicago (IL); On-site; USD 70,000 - 110,000; Full time

Benefits offered by this job

Competitive compensation

401(k) with match

BCBS Medical Insurance

Dental, Vision, Disability insurance

Paid Time Off

Growth opportunities

Job summary

Pavilion of Logan Square is seeking a diligent MDS Auditor to review and audit MDS assessments for compliance with RAI guidelines and regulatory and payer requirements. You will perform routine audits, validate documentation, and ensure accurate reimbursement classifications across multiple facilities.

Ideal candidates hold RN/LPN credentials with a healthcare degree and have experience with MDS 3.0, reimbursement methodologies, and EMR/MDS software.

Qualifications

• Knowledge of MDS processes and RAI requirements.
• Understanding of reimbursement methodologies and case mix 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.
• Excellent written and verbal communication skills.
• Strong organizational and time-management skills.
• Proficiency with EMR, MDS software, and Office applications.
• Ability to analyze data trends across facilities and identify systemic risks.
• Ability to translate audit findings into actionable recommendations.

Responsibilities

• Perform routine audits of MDS assessments across facilities for compliance and accuracy.
• Review MDS assessments for accuracy, completeness, and supporting documentation.
• Audit coding accuracy and validate documentation for MDS items impacting reimbursement.
• Review CMG components and documentation for accurate reimbursement classification.
• Audit Section GG documentation for consistency with medical records and regulations.
• Review Medicare Part A certifications and recertifications for regulatory compliance.
• Verify assessment dates, schedules, transmission requirements, and timelines.
• Identify discrepancies and communicate findings to facility and corporate leadership.
• Maintain audit logs and supporting documentation per procedures.
• Complete audits within established timelines and productivity expectations.
• Monitor updates to MDS manuals and payer requirements related to audits.
• Conduct trend analysis to identify systemic issues across facilities.
• Develop and maintain corporate audit tools, templates, and processes.
• Recommend corrective actions and monitor implementation.
• Participate in corporate compliance and reimbursement meetings to report trends.

Skills

MDS knowledge

Reimbursement knowledge

Section GG knowledge

Attention to detail

Efficient documentation review

Communication skills

Time management

EMR/MDS software

Data trend analysis

Audit findings to actions

Education

RN/LPN license

Healthcare degree

MDS 3.0 knowledge

Audit experience

Tools

Microsoft Office

Job description

Pavilion of Logan Square is seeking a diligent MDS Auditor to review and audit MDS assessments for compliance with RAI guidelines and regulatory and payer requirements. You will perform routine audits, validate documentation, and ensure accurate reimbursement classifications across multiple facilities.

Ideal candidates hold RN/LPN credentials with a healthcare degree and have experience with MDS 3.0, reimbursement methodologies, and EMR/MDS software.