MDS Auditor: Compliance & Revenue Integrity

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 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.