MDS/PDPM Reimbursement Specialist

PACS Group; United States; On-site; USD 85,000 - 120,000; Full time

Benefits offered by this job

Health coverage

401(k)

PTO / Vacation

EAP

Job summary

PACS Group is seeking a Clinical Reimbursement Consultant to partner with facility teams and ensure accurate, compliant reimbursement under Medicare, Medicaid, and managed care programs. The role focuses on MDS accuracy, PDPM optimization, and documentation practices that support appropriate reimbursement and regulatory compliance.

Responsibilities include on-site and remote MDS reviews, collaboration with MDS coordinators and DONs, and training staff on coding and regulatory updates across

Qualifications

• 3+ years of MDS coordination or clinical reimbursement in post-acute settings.
• Strong knowledge of PDPM and RUG-IV.
• Experience with MDS software like PointClickCare or MatrixCare.

Responsibilities

• Conduct on-site and remote reviews of MDS assessments for accuracy and PDPM classification.
• Partner with MDS coordinators, DONs, and teams to strengthen documentation supporting care levels.
• Monitor reimbursement data to identify trends, risks, and opportunities.
• Educate facility staff on MDS coding, look-back periods, and CMS/state updates.
• Support pre-billing reviews to reduce denials and errors.
• Prepare facilities for surveys and RAC/UPIC audits.
• Report reimbursement metrics to regional and corporate leadership.
• Stay updated on PDPM and Medicaid changes across states.

Skills

MDS coordination

PDPM knowledge

MDS software (PC/MX)

Travel readiness

Education

RN or LPN license

RAC-CT certification preferred

Tools

PointClickCare

MatrixCare

Job description

PACS Group is seeking a Clinical Reimbursement Consultant to partner with facility teams and ensure accurate, compliant reimbursement under Medicare, Medicaid, and managed care programs. The role focuses on MDS accuracy, PDPM optimization, and documentation practices that support appropriate reimbursement and regulatory compliance.

Responsibilities include on-site and remote MDS reviews, collaboration with MDS coordinators and DONs, and training staff on coding and regulatory updates across