Senior SNF Auditor (Remote) – PDPM/RUG & Compliance

EXL; Oregon; Hybrid; USD 60,000 - 99,000; Full time

Job summary

EXL is seeking a Skilled Nursing Facility auditor to validate billed charges, applying CMS guidelines, PDPM/RUG concepts, and HIPPS knowledge. This fully remote role conducts clinical reviews, documents audit findings, and supports opportunities to improve reimbursement integrity.

You will rely on EXL tools and industry standards, work with cross-functional teams, and maintain HIPAA compliance while delivering accuracy and timely audit determinations.

Qualifications

• Active nursing license (RN/LPN/LVN) required.
• 3+ years of skilled nursing auditing experience.
• RAC certification preferred; knowledge of PDPM/RUG.
• Experience with PDPM, RUG, Medicare reimbursement systems.
• Experience with HIPPS codes and days of billing.

Responsibilities

• Conduct clinical reviews to verify SNF billing accuracy.
• Apply CMS guidelines to identify overpayments under PDPM, RUG, and per diem.
• Apply ICD-10 coding guidelines to validate MDS diagnoses.
• Document audit results clearly using EXL tools and CMS guidelines.
• Move claims through workflow, generate audit rationales, and meet productivity goals.
• Maintain HIPAA compliance and regulatory requirements.

Skills

RN/LPN/LVN license

Skilled nursing experience

RAC certification preferred

PDPM/RUG knowledge

HIPPS billing knowledge

Strong communication & analytical

Remote work independently

Education

Associate's or Bachelor's degree in nursing

Bachelor's degree preferred

Tools

EXL proprietary tools

Excel

Job description

EXL is seeking a Skilled Nursing Facility auditor to validate billed charges, applying CMS guidelines, PDPM/RUG concepts, and HIPPS knowledge. This fully remote role conducts clinical reviews, documents audit findings, and supports opportunities to improve reimbursement integrity.

You will rely on EXL tools and industry standards, work with cross-functional teams, and maintain HIPAA compliance while delivering accuracy and timely audit determinations.