PDPM & MDS Reimbursement Consultant

PACS in; Salt Lake City (UT); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Health Coverage

PTO and Holidays

401(k) plan

Employee Assistance Plan (EAP)

Job summary

PACS Group seeks a Clinical Reimbursement Consultant to optimize Medicare/Medicaid reimbursement across post-acute facilities. You will lead MDS accuracy reviews, PDPM classification, and case‑mix improvement while guiding facility teams on documentation best practices.

You will collaborate with nursing and business offices to reduce denials, support audits, and ensure regulatory compliance across multiple states. Strong PDPM knowledge and MDS software experience are essential.

Qualifications

• Active RN or LPN license (or RAC-CT certification preferred).
• 3+ years of MDS coordination or clinical reimbursement in skilled nursing/post-acute.
• Strong working knowledge of PDPM, RUG‑IV, and state Medicaid systems.
• Experience with MDS software such as PointClickCare or MatrixCare.

Responsibilities

• Conduct on-site and remote reviews of MDS assessments for accuracy and PDPM classification.
• Collaborate with facility teams to strengthen documentation for appropriate case-mix and reimbursement.
• Monitor facility reimbursement data to identify trends, risks, and opportunities.
• Educate facility teams on MDS coding, look-back periods, and CMS/state Medicaid updates.
• Support pre-billing checks to minimize denials and errors.
• Prepare facilities for state/federal surveys and RAC/UPIC audits.
• Report key metrics to regional and corporate leadership.

Skills

MDS coordination

PDPM knowledge

RUG-IV knowledge

Regulatory compliance

Education

RN/LPN license

RAC-CT certification

Tools

PointClickCare

MatrixCare

Job description

PACS Group seeks a Clinical Reimbursement Consultant to optimize Medicare/Medicaid reimbursement across post-acute facilities. You will lead MDS accuracy reviews, PDPM classification, and case‑mix improvement while guiding facility teams on documentation best practices.

You will collaborate with nursing and business offices to reduce denials, support audits, and ensure regulatory compliance across multiple states. Strong PDPM knowledge and MDS software experience are essential.