PDPM & MDS Reimbursement Consultant — Travel

PACS; Salt Lake City (UT); On-site; USD 80,000 - 110,000; Full time

Benefits offered by this job

Health coverage

PTO and holidays

Financial wellness (HSA/FSA)

401(k) with company contributions

Employee Assistance Plan (EAP)

Job summary

PACS Group is seeking a Clinical Reimbursement Consultant to collaborate with facility clinical and business teams to ensure accurate and compliant reimbursement under Medicare, Medicaid, and managed care programs. You will guide MDS accuracy, PDPM optimization, and documentation practices to support appropriate reimbursement.

You will work with facility MDS coordinators and interdisciplinary teams, monitor PDPM and Medicaid trends, and provide training on MDS coding and regulatory updates.

Qualifications

• RN or LPN license (or equivalent clinical license) is required.
• 3+ years of MDS coordination or clinical reimbursement experience in skilled nursing/post-acute settings.
• Strong knowledge of PDPM, RUG-IV, and state Medicaid case-mix systems.
• Experience with MDS software such as PointClickCare or MatrixCare.

Responsibilities

• Conduct on-site and remote reviews of MDS assessments for accuracy, timeliness, and PDPM classification integrity.
• Partner with facility MDS coordinators, DONs, and interdisciplinary teams to strengthen documentation supporting skilled level of care and case-mix indices.
• Monitor and analyze facility-level reimbursement data (PDPM, RUG scores, Medicaid case-mix) to identify trends, risks, and opportunities.
• Provide education and training on MDS coding, look-back periods, and regulatory updates (CMS, state Medicaid).
• Support pre-billing reviews to reduce claim denials and payment errors.
• Conduct mock audits and prepare facilities for state/federal surveys and RAC/UPIC audits.
• Track and report key reimbursement metrics to regional and corporate leadership.
• Stay current on PDPM, Medicaid case-mix, and managed care reimbursement methodology changes.

Skills

MDS coordination

PDPM knowledge

RUG-IV knowledge

State Medicaid case-mix

Analytical communication

Education

RN/LPN license

RAC-CT certification (preferred)

Tools

PointClickCare

MatrixCare

Job description

PACS Group is seeking a Clinical Reimbursement Consultant to collaborate with facility clinical and business teams to ensure accurate and compliant reimbursement under Medicare, Medicaid, and managed care programs. You will guide MDS accuracy, PDPM optimization, and documentation practices to support appropriate reimbursement.

You will work with facility MDS coordinators and interdisciplinary teams, monitor PDPM and Medicaid trends, and provide training on MDS coding and regulatory updates.