MDS/PDPM Reimbursement Specialist (RN/LPN)

Terrace of St. Cloud; Florida; On-site; USD 72,000 - 88,000; Full time

Benefits offered by this job

Sign on Bonus

Job summary

Terrace of Saint Cloud in Saint Cloud, FL is seeking a Clinical Reimbursement Specialist RN/LPN to coordinate MDS, assessments, and PDPM compliance on-site with the Nursing team.

This full-time role partners with Administration, the MDS team, therapy, and the Business Office to ensure accurate documentation and appropriate reimbursement per CMS/state rules.

The position supports resident care quality and facility financial health, with a sign-on bonus and opportunities for professional growth.

Qualifications

• Minimum of three years in MDS, clinical reimbursement, utilization review, or skilled nursing.
• Experience with MDS 3.0, RAI, PDPM, Medicare Part A/Medicare Advantage, Medicaid reimbursement.
• Proficiency with electronic medical record systems, MDS software, Microsoft Office, and basic spreadsheet reporting.

Responsibilities

• Coordinate MDS assessments calendar, reference dates, transmission deadlines and corrections.
• Oversee PDPM components and reimbursed services; monitor admissions and payer changes.
• Conduct concurrent and retrospective audits to verify documentation supports skilled services and reimbursement.
• Perform compliance/audit activities and participate in QA/QI processes.
• Provide education and corrective action recommendations to staff as needed.
• Assist with pre-billing reviews and denial/appeal notices as required.

Skills

MDS coordination

PDPM

Medicare/Medicaid reimbursement

MDS scheduling

Documentation accuracy

Interdisciplinary communication

Education

Active Florida RN or LPN license

Job description

Terrace of Saint Cloud in Saint Cloud, FL is seeking a Clinical Reimbursement Specialist RN/LPN to coordinate MDS, assessments, and PDPM compliance on-site with the Nursing team.

This full-time role partners with Administration, the MDS team, therapy, and the Business Office to ensure accurate documentation and appropriate reimbursement per CMS/state rules.

The position supports resident care quality and facility financial health, with a sign-on bonus and opportunities for professional growth.