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Pdpm Audit Jobs in Florida (NOW HIRING)

Skilled Nursing Facility

MDS Coordinator

Clearwater, FL

$31.50 - $40.25/hr

Key Responsibilities PDPM & Reimbursement Oversight * Maintain and update the Regional PDPM Review ... Auditing & Additional Support * Assist in completing requested audits to ensure compliance and ...

Skilled Nursing Facility

MDS Coordinator

Sarasota, FL

$33 - $42.25/hr

Key Responsibilities PDPM & Reimbursement Oversight * Maintain and update the Regional PDPM Review ... Auditing & Additional Support * Assist in completing requested audits to ensure compliance and ...

Bear Creek Nursing

MDS Coordinator, RN

Hudson, FL · On-site

$33.25 - $40/hr

If you are confident in PDPM, experienced in reviewing Quality Measures, and comfortable working ... Track Case Mix Index (CMI) trends and participate in reimbursement audits * Educate nursing staff ...

Apex Healthcare

RN MDS Coordinator - 3610801

Miami, FL · On-site

$100K - $120K/yr

Knowledge of PDPM and reimbursement systems * Strong organizational and communication skills ... Monitor documentation to support reimbursement accuracy * Assist with audit preparation and ...

Apex Healthcare

RN MDS Coordinator - 3610801

Miami, FL

$100K - $120K/yr

Knowledge of PDPM and reimbursement systems * Strong organizational and communication skills ... Monitor documentation to support reimbursement accuracy * Assist with audit preparation and ...

Apex Healthcare

RN MDS Coordinator

Miami, FL · On-site

$35.75 - $43/hr

Knowledge of PDPM and reimbursement systems * Strong organizational and communication skills ... Monitor documentation to support reimbursement accuracy * Assist with audit preparation and ...

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Pdpm Audit information

What is a PDPM audit?

A PDPM audit is an evaluation process that reviews how a skilled nursing facility implements the Patient-Driven Payment Model (PDPM). Auditors examine clinical documentation, coding, and billing practices to ensure compliance with Medicare regulations and to verify that residents are being accurately assessed and classified for payment. The goal is to identify errors or discrepancies that could lead to improper payments or regulatory issues, and to help facilities improve their processes for accurate reimbursement. Regular PDPM audits can help facilities avoid penalties and maintain financial stability.

What are the key skills and qualifications needed to thrive as a PDPM auditor?

To thrive as a PDPM Auditor, you need a solid understanding of Medicare reimbursement systems, MDS (Minimum Data Set) assessments, and skilled nursing facility regulations, typically supported by clinical credentials such as RN, LPN, or certification in MDS/RAI. Familiarity with electronic health record (EHR) systems, PDPM calculation software, and audit tools is essential. Strong analytical thinking, attention to detail, and effective communication skills help ensure accuracy and clarity when reviewing records and providing feedback. These skills are vital to optimize reimbursement, maintain regulatory compliance, and support quality patient care.

What are some common challenges faced by professionals conducting PDPM audits in skilled nursing facilities?

Professionals performing PDPM (Patient-Driven Payment Model) audits often encounter challenges such as ensuring accurate clinical documentation, keeping up with frequent regulatory changes, and effectively communicating findings to interdisciplinary teams. They must carefully review MDS assessments, therapy documentation, and nursing notes to verify compliance and reimbursement accuracy. Additionally, working collaboratively with clinical and administrative staff is crucial for implementing corrective actions and maintaining ongoing compliance.

What is the difference between Pdpm Audit vs Pdpm Compliance Officer?

AspectPdpm AuditPdpm Compliance Officer
Primary RoleConducts audits to ensure adherence to Pdpm standards and regulationsEnsures organizational compliance with Pdpm policies and external regulations
CertificationsOften requires auditing or quality assurance certificationsRequires compliance or regulatory certifications
Work EnvironmentAuditing in various departments, often in a review or assessment capacityMonitoring and implementing compliance measures across the organization
Industry UsageCommon in healthcare, manufacturing, and service sectorsPrevalent in healthcare, finance, and regulated industries

While both roles focus on adherence to Pdpm standards, Pdpm Audits primarily evaluate compliance through assessments, whereas Pdpm Compliance Officers develop and oversee compliance programs to ensure ongoing adherence.

What are popular job titles related to Pdpm Audit jobs in Florida?

For Pdpm Audit jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Pdpm Audit jobs in Florida look for?

The top searched job categories for Pdpm Audit jobs in Florida are:

What cities in Florida are hiring for Pdpm Audit jobs?

Cities in Florida with the most Pdpm Audit job openings:

Pdpm Audit jobs near you
Infographic showing various Pdpm Audit job openings in Florida as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Clinical Reimbursement Specialist RN/LPN

The Terrace of St. Cloud

Saint Cloud, FL • On-site

$90K - $100K/yr

Full-time

Re-posted 8 days ago

Job description

Position Summary
The Clinical Reimbursement Specialist is an on-site facility resource responsible for coordinating and monitoring the Minimum Data Set (MDS), resident assessment, care-planning, skilled coverage, and reimbursement processes. The position works directly with the Administrator, Director of Nursing, MDS team, therapy, Business Office, medical providers, and interdisciplinary team to ensure that resident assessments are accurate, timely, clinically supported, and compliant with Medicare, Medicaid, managed care, the Patient-Driven Payment Model (PDPM), and applicable federal and state requirements.
The specialist maintains daily visibility into facility admissions, payer changes, clinical changes, assessment schedules, documentation quality, authorization requirements, and reimbursement risks. The role supports appropriate reimbursement only when it is fully supported by the resident's condition, services provided, and the medical record.
Essential Duties and Responsibilities
1. MDS and Assessment Coordination
  • Maintain the facility MDS assessment calendar and monitor all assessment reference dates, completion dates, transmission deadlines, and required corrections.
  • Coordinate comprehensive, quarterly, significant-change, significant-correction, entry, discharge, and Medicare assessments in accordance with the RAI Manual and CMS requirements.
  • Review MDS coding for consistency with the resident's current condition, diagnoses, functional status, clinical services, therapy services, restorative programs, and supporting documentation.
  • Monitor Care Area Assessments, care-plan development, and interdisciplinary participation to ensure identified needs are addressed and documentation is complete.
  • Track rejected submissions, validation reports, warning messages, late assessments, modifications, and inactivations through resolution.
  • Provide coverage or direct assistance with MDS completion when operationally necessary and within the employee's licensure and competency.

2. Clinical Reimbursement and PDPM Oversight
  • Review Medicare Part A, Medicare Advantage, Medicaid, managed care, and other payer-related clinical documentation and reimbursement requirements.
  • Validate PDPM components, including diagnoses, nursing classification, functional scoring, non-therapy ancillary services, speech-language pathology factors, and therapy utilization, as applicable.
  • Monitor admissions, hospital returns, changes in condition, payer changes, interrupted stays, and other events that may affect assessment or reimbursement requirements.
  • Identify potential missed reimbursement, unsupported coding, documentation inconsistencies, or compliance risks and promptly communicate findings to facility leadership.
  • Participate in Triple Check and other pre-billing reviews to validate census, covered days, payer source, assessment completion, physician certification, authorization, and supporting documentation.
  • Collaborate with the Business Office and managed care personnel to monitor authorizations, continued-stay reviews, notices, denials, and appeal deadlines.

3. Clinical Documentation Review
  • Conduct routine concurrent and retrospective medical record audits to verify that documentation supports skilled coverage, medical necessity, diagnoses, MDS coding, services rendered, and reimbursement.
  • Review nursing documentation, physician and practitioner notes, hospital records, therapy documentation, medication and treatment records, restorative nursing records, care plans, and other supporting assessments.
  • Identify documentation gaps, conflicting information, copy-forward concerns, incomplete records, or untimely entries and provide clear corrective guidance.
  • Promote resident-specific documentation that describes the resident's condition, risks, skilled needs, interventions, progress, response to treatment, and discharge potential.
  • Follow up on identified deficiencies to verify timely correction and sustained improvement.

4. Compliance, Auditing, and Quality Improvement
  • Maintain current knowledge of CMS requirements, the RAI Manual, PDPM, Medicare coverage criteria, Medicaid case-mix requirements, managed care rules, and applicable state regulations.
  • Conduct scheduled and focused audits based on facility risk, survey findings, denials, quality trends, late assessments, or leadership direction.
  • Assist with additional documentation requests, medical reviews, payer audits, denials, appeals, and reimbursement-related inquiries.
  • Develop written findings, corrective action recommendations, education plans, and follow-up monitoring when deficiencies are identified.
  • Participate in the Quality Assurance and Performance Improvement process and present reimbursement, assessment, and documentation trends as assigned.
  • Maintain resident confidentiality and comply with HIPAA, privacy, security, infection-control, and facility policies.

5. Key Performance Expectations
  • MDS assessments are completed, transmitted, and corrected accurately and within required timeframes.
  • PDPM and case-mix classifications are accurate and supported by resident-specific clinical documentation.
  • Skilled coverage and medical necessity documentation are complete, timely, and consistent across disciplines.
  • Triple Check and pre-billing reviews are completed before claim submission, with identified discrepancies resolved or escalated.
  • Assessment rejections, late submissions, reimbursement denials, and repeat documentation deficiencies are reduced.
  • Facility staff receive timely education, practical feedback, and follow-up support.
  • Audit findings and corrective actions are documented, communicated, and monitored through completion.

6. Required Qualifications
  • Current, active Registered Nurse license in the state of practice is preferred. A Licensed Practical Nurse with substantial MDS and skilled nursing reimbursement experience may be considered based on facility requirements.
  • Minimum of three years of MDS, clinical reimbursement, utilization review, or skilled nursing experience.
  • Working knowledge of MDS 3.0, the RAI process, PDPM, Medicare Part A, Medicare Advantage, Medicaid reimbursement, managed care, skilled documentation, and care planning.
  • Experience completing, reviewing, or auditing MDS assessments and supporting clinical records.
  • Proficiency with electronic medical record systems, MDS software, Microsoft Office, and basic spreadsheet reporting.
  • Strong analytical, organizational, communication, education, and problem-solving skills.
  • Ability to manage multiple deadlines, maintain confidentiality, and exercise sound clinical and compliance judgment.

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