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Pdpm Audit Jobs in Indiana (NOW HIRING)

The Milton Home

MDS Coordinator RN Preferred

South Bend, IN

$33.50 - $43/hr

Manage PDPM case mix including clinical categories, NTA scoring, and therapy minutes * Lead or co ... Conduct internal MDS audits to ensure coding accuracy and compliance * Educate nursing staff on ...

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Pdpm Audit information

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 the key skills and qualifications needed to thrive as a PDPM Auditor, and why are they important?

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 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 popular job titles related to Pdpm Audit jobs in Indiana? For Pdpm Audit jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Pdpm Audit jobs in Indiana look for? The top searched job categories for Pdpm Audit jobs in Indiana are:
Pdpm Audit jobs near you
Infographic showing various Pdpm Audit job openings in Indiana as of July 2026, with employment types broken down into 2% As Needed, 91% Full Time, and 7% Part Time. Highlights an 97% In-person, and 3% Hybrid job distribution.

Regional RAI Specialist (RN) - Clinical Reimbursement

Confidential Healthcare Facility

Fort Wayne, IN

Full-time

Posted yesterday

Job description

Regional RAI Specialist (RN) – Clinical Reimbursement

Location: Fort Wayne, IN (Supporting Northern Indiana Territory)
Company: Clinical Consulting Services (CCS)

Schedule: This is NOT a fully remote role

Lead Clinical Reimbursement Excellence Across Northern Indiana

Clinical Consulting Services (CCS) is seeking an experienced Regional RAI Specialist (RN) to support multiple skilled nursing facilities throughout Northern Indiana. Candidates should be based in or near the Fort Wayne area and be comfortable traveling throughout the assigned territory.

This is an outstanding opportunity for an experienced Registered Nurse who is passionate about MDS accuracy, clinical reimbursement, regulatory compliance, and mentoring facility teams. If you thrive in a collaborative environment where you can make a meaningful impact on both resident care and facility performance, we'd love to hear from you.

Why Join CCS?

  • Comprehensive Benefits Package

  • Mileage & Travel Reimbursement

  • Opportunities for Career Growth and Advancement

  • Supportive Regional Leadership

  • Collaborative, Team-Focused Culture

  • Opportunity to positively impact multiple skilled nursing facilities

Responsibilities

  • Provide clinical reimbursement and RAI/MDS support to facility-based MDS Coordinators throughout Northern Indiana.

  • Ensure accurate and timely completion and submission of all MDS assessments.

  • Conduct routine MDS and reimbursement audits to ensure compliance with state and federal regulations.

  • Educate and mentor facility teams on RAI processes, PDPM reimbursement, regulatory updates, and documentation best practices.

  • Partner with Administrators, Directors of Nursing, MDS Coordinators, and interdisciplinary teams to improve clinical and financial outcomes.

  • Assist facilities in optimizing Case Mix Index (CMI), PDPM reimbursement, and Quality Measures.

  • Identify opportunities for process improvement and provide ongoing education and operational support.

  • Serve as a clinical reimbursement resource for multiple skilled nursing facilities within the region.

Qualifications

  • Active Registered Nurse (RN) license required.

  • Minimum of five (5) years of MDS/RAI experience in a skilled nursing facility.

  • Extensive knowledge of PDPM, Medicare and Medicaid reimbursement, and skilled nursing regulations.

  • Previous experience mentoring, educating, or supporting MDS teams.

  • Strong analytical, organizational, problem-solving, and communication skills.

  • Ability to travel throughout the Northern Indiana territory.

Join Our Team

At Clinical Consulting Services (CCS), we partner with skilled nursing facilities to deliver expert clinical reimbursement support, regulatory guidance, and operational excellence. If you're an experienced RN looking to expand your impact beyond a single facility while working with a supportive and respected regional team, we encourage you to apply today.

INDCONFRNAC