Temp Part-time, Skilled Nursing Facility – Patient-Driven Payment Model
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Job Description
SNF/PDPM Quality Analyst reviewing clinical coding and reimbursement audits for EXL Health. Ensuring CMS compliance, audit accuracy, and healthcare quality improvement.
Responsibilities:
- Perform quality reviews of completed SNF/PDPM audits to validate coding accuracy, reimbursement determinations, supporting documentation, and audit rationale
- Ensure audit findings align with CMS guidelines, RAI Manual requirements, PDPM regulations, client requirements, and departmental procedures
- Document quality review findings clearly and accurately
- Identify quality trends, recurring audit errors, and opportunities for process improvement
- Provide constructive written feedback to auditors
- Achieve productivity and quality goals
- Respond timely to emails and meeting requests and attend scheduled meetings
- Participate in discussions and team meetings, providing improvement suggestions or volunteering when needed
- Adhere to EXL Health policies and procedures
- Report audit or quality-process problems to the Quality Manager for resolution
- Identify and communicate facility- and provider-specific issues affecting audits
- Maintain current knowledge of CMS regulations, PDPM reimbursement methodology, MDS 3.0 requirements, and industry best practices
- Monitor regulatory changes affecting SNF/PDPM auditing activities
Requirements:
- Registered Nurse, Licensed Practical Nurse, or Licensed Vocational Nurse license in good standing in the state that you reside
- Minimum of 5 years’ experience with SNF clinical, MDS 3.0 completion, PDPM reimbursement methodology, quality assurance, auditing, and/or related experience
- Advanced knowledge of MDS 3.0 coding guidelines, skilled nursing facility (SNF) levels of care, and PDPM reimbursement
- Previous experience/exposure to the billing of HIPPS codes
- Experience reviewing audit findings, conducting quality revises, or performing compliance monitoring activities
- Experience with Excel, PowerPoint, Outlook, and Word
- Experience with Encoder tools such as 3M
- Experience with and expertise with Medicare Local Coverage Determinations (LCD) and National Coverage Determinations (NCD)
- Must be detail oriented
- Must have excellent verbal and written communication skills
- Must be self-directed and able to work with minimum oversight
Benefits:
- Remote work flexibility
- Up to 10% annual travel for team meetings and limited client onsite engagements
- Opportunities for growth and mentorship through a structured coaching program
- Collaborative culture where ideas and insights are valued
- Opportunities for advancement
- Fast-paced, innovative environment with a team of driven professionals
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