PDPM Skilled Specialists

PDPM Support Specialist
Why Join Our Team?

As a PDPM Support Specialist, you will play an important role in strengthening clinical documentation, regulatory compliance, reimbursement accuracy, and MDS performance across our skilled nursing facilities. This position provides an opportunity to partner directly with facility and regional leadership while helping clinical teams navigate the complexities of PDPM and Medicare reimbursement.

• Multi-facility clinical and reimbursement support role
• Opportunity to develop and educate MDS and interdisciplinary teams
• Direct impact on documentation accuracy, compliance, and reimbursement integrity
• Collaborative partnership with clinical, operational, and billing leadership
• Opportunity to strengthen systems and processes across multiple facilities

We are seeking an experienced and detail-oriented PDPM Support Specialist to provide auditing, education, and operational support to our skilled nursing facilities.

The PDPM Support Specialist is responsible for reviewing skilled resident documentation and MDS-related processes to promote accurate Patient Driven Payment Model (PDPM) classification, appropriate reimbursement, and compliance with CMS requirements.

This position will work closely with MDS Coordinators, nursing leadership, interdisciplinary teams, billing personnel, facility Administrators, and regional leadership to identify documentation opportunities, address compliance concerns, provide education, and strengthen facility-level processes.

The successful candidate will possess a strong understanding of PDPM, the Resident Assessment Instrument (RAI), Medicare documentation, HIPPS coding, and skilled nursing reimbursement requirements.

PDPM Auditing & Documentation Oversight

• Conduct comprehensive audits of skilled resident records to evaluate documentation supporting PDPM classification and reimbursement

• Review Medicare Part A and managed care resident records for documentation accuracy, completeness, and compliance

• Evaluate clinical documentation supporting MDS coding and HIPPS code assignments

• Identify documentation deficiencies, inconsistencies, and opportunities requiring additional review or clarification

• Review supporting documentation for alignment with applicable CMS requirements and facility processes

• Conduct audits designed to strengthen preparedness for Medicare Administrative Contractor (MAC) and Recovery Audit Contractor (RAC) review

• Monitor trends in documentation, coding, and reimbursement practices across assigned facilities

• Escalate identified compliance concerns, discrepancies, or potential fraud, waste, or abuse through appropriate organizational channels

MDS Support, Education & Development

• Provide ongoing education to MDS Coordinators and interdisciplinary team members regarding PDPM documentation and CMS requirements

• Provide timely, actionable feedback regarding PDPM capture opportunities, documentation deficiencies, and areas requiring improvement

• Support MDS Coordinators in strengthening the accuracy and consistency of PDPM-related processes

• Provide applicable PDPM section information to facility teams within established time frames and follow up with leadership regarding utilization

• Educate clinical and operational staff regarding documentation practices necessary to appropriately support resident acuity, services, and reimbursement

• Assist facility teams in understanding the relationship between clinical documentation, MDS coding, PDPM classification, and reimbursement

• Promote a culture centered on documentation integrity, regulatory compliance, and continuous improvement

Collaboration & Operational Support

• Partner with facility leadership and interdisciplinary teams to promote complete and accurate documentation supporting PDPM reimbursement

• Collaborate with the billing department to support timely completion of PDPM-related billing processes

• Communicate audit findings, trends, identified risks, and improvement opportunities to facility and regional leadership

• Follow up on identified deficiencies and support facilities in developing sustainable corrective processes

• Serve as a resource to MDS Coordinators and facility leadership regarding PDPM-related questions and documentation practices

• Maintain organized records of audits, findings, education, recommendations, and follow-up activities

• Support consistency and accountability in PDPM processes across assigned facilities

This is a multi-facility support position requiring regular…