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Pdpm Audit Jobs (NOW HIRING)

KALESTA HEALTHCARE GROUP

MDS CONSULTANT RN

Rocklin, CA

$38.75 - $46.75/hr

... Audit and trend analysis of MDS-related deficiencies with actionable corrective plans PDPM & Reimbursement · Accurate PDPM coding, case mix grouping, and clinical documentation review · ...

Evercare

Regional MDS Consultant

Belleville, IL · On-site

$33.25 - $42.50/hr

Monitor PDPM performance and reimbursement opportunities while ensuring compliance with federal and state regulations. * Conduct routine audits of MDS assessments, supporting documentation, care ...

lhs

Physical Therapist Director

Wickliffe, OH · On-site

$84K - $99K/yr

Prepare for and participate in surveys, audits, and compliance reviews. Reimbursement & Financial Performance * Manage and optimize PDPM case mix index (CMI) through collaboration with MDS and ...

The McGuire Group

MDS Lead RN

Williamsville, NY

$36 - $37/hr

You'll also provide education and support to facility staff while overseeing MDS processes and assisting with reimbursement-related audits and reviews. If you have experience with MDS, PDPM, and ...

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All JobsPdpm Audit Jobs

Pdpm Audit information

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$61K

$120.2K

$157.5K

How much do pdpm audit jobs pay per year?

As of Jul 2, 2026, the average yearly pay for pdpm audit in the United States is $120,236.00, according to ZipRecruiter salary data. Most workers in this role earn between $104,000.00 and $136,500.00 per year, depending on experience, location, and employer.

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.
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Pdpm Audit jobs near you
Regional Clinical Reimbursement Consultant - State Veterans Homes

Regional Clinical Reimbursement Consultant - State Veterans Homes

STG International, Inc.

Greensboro, NC • On-site

$87K - $118K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 23 days ago

Job description

THIS IS FOR A FUTURE OPENING

Regional Clinical Reimbursement Consultant  – State Veterans Homes     

STGi is seeking qualified candidates for this position in connection with an active Request for Proposals (RFP).   Hiring for this role is contingent upon STGi’s selection as the successful awardee.

JOB SUMMARY: 

The Regional Clinical Reimbursement Consultant (RCRC) provides leadership and oversight of clinical reimbursement processes across multiple long-term care facilities within an assigned region. This role ensures accurate and compliant MDS completion, optimized reimbursement under PDPM, regulatory compliance, and consistent application of best practices while partnering with clinical, financial, and operational leaders to drive outcomes.  Travel is required and is extensive throughout assigned region.

ESSENTIAL FUNCTIONS: 

Clinical Reimbursement & PDPM Oversight 

  • Oversee clinical reimbursement operations across multiple skilled nursing facilities 

  • Ensure accurate, timely, and compliant completion of MDS assessments in accordance with CMS requirements 

  • Monitor PDPM performance, case-mix accuracy, and reimbursement trends 

  • Identify opportunities to optimize reimbursement while maintaining clinical integrity and compliance 

MDS & Documentation Support 

  • Provide guidance and oversight to MDS Coordinators and facility leadership 

  • Ensure interdisciplinary documentation supports clinical conditions, diagnoses, and care needs 

  • Support MDS scheduling, care area assessments (CAAs), and care planning processes 

Compliance & Audit Management 

  • Ensure compliance with federal and state regulations, RAI Manual, and payer requirements 

  • Support internal and external audits, including medical record reviews and ADRs 

  • Lead corrective action plans related to MDS, documentation, and reimbursement findings 

Education & Training 

  • Develop and deliver ongoing education related to PDPM, MDS, ICD-10 coding, and documentation standards 

  • Support onboarding and competency development of MDS and clinical reimbursement staff 

  • Stay current on CMS updates, rule changes, and industry best practices 

Reporting & Analytics 

  • Review and analyze reimbursement and quality data, including PDPM components, case-mix indices, and revenue impacts 

  • Provide regular reporting and recommendations to regional and corporate leadership 

  • Partner with business office and clinical teams to resolve billing, denials, and reimbursement issues 

Collaboration & Leadership 

  • Work closely with Regional Clinical, Operations, and Finance leadership 

  • Serve as a regional resource for reimbursement-related questions and problem resolution 

  • Promote a culture of compliance, accuracy, and continuous improvement 


Required Skills

REQUIRED EXPERIENCE AND SKILLS: 

Required 

  • Active Registered Nurse (RN) license in good standing 

  • Bachelor’s degree in Nursing or related field (BSN required) 

  • Minimum 5–7 years of MDS and clinical reimbursement experience in long-term care 

  • Strong knowledge of PDPM, RAI Manual, ICD-10 coding, and CMS regulations 

  • Experience supporting audits and survey processes 

  • Ability to travel regularly within assigned region 

Preferred 

  • Prior regional or multi-facility reimbursement leadership experience 

  • RAC-CT, DNS-CT, or similar certification 

  • Master’s degree in Nursing, Healthcare Administration, or related field 

Skills & Competencies 

  • Strong analytical and financial acumen 

  • Excellent attention to detail and regulatory knowledge 

  • Effective leadership, coaching, and education skills 

  • Clear written and verbal communication 

  • Ability to manage multiple facilities and priorities 


Required Experience

REQUIRED EDUCATION: 

  • Active Registered Nurse (RN) license in good standing 

  • Bachelor’s degree in Nursing or related field (BSN required) 

 WORKING CONDITIONS/PHYSICAL REQUIREMENTS:  

The physical demands and work environment described herein is a representative of those that generally must be met by a team member to successfully perform the essential functions of this job:  

• This position primarily involves sitting, standing, walking, twisting, reaching, bending/stooping, pushing and pulling (typical weight of 5 lbs. and maximum weight of 100 lbs., approximately), and lifting (minimum weight of 5 lbs. and maximum weight of 100 lbs., approximately)  

• The position requires repetitive finger movements as well as hearing and talking on the phone and in person.  

• Must be able to continuously deal effectively with stress created by residents, multiple tasks, noises, interruptions, and work cooperatively as part of the health care team while maintaining a pleasant attitude  

DISCLAIMER 

The preceding job description has been designed to indicate the general nature and level of work performed by employees within this classification.  It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job. 

STGi is a workforce solutions company providing comprehensive healthcare delivery, Head Start and management consulting services and human capital solutions help our clients. Our services and solutions help our clients sustain and enhance their operations to better accomplish their mission.

STGi offers a competitive benefits package which includes Medical, Dental, Vision, 401k with company match and a generous PTO policy.

STGi is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class.

Medical Corps - 60J, 60L, 61F, 61H, 61N, 61R,62B Medical Specialist Corps - 65B, 65C, 65D Nurse Corps - 66B,66H, 66P Medical Service Corps – 67G, 67J Medical CMF – 68A, 68B, 68E, 68F, 68G, 68J, 68Q, 68R, 68S, 68T, 68W, 68X, 68Y

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About STG International

Sourced by ZipRecruiter

STG International is a leading organization in the field of Professional Services, providing a wide variety of solutions in healthcare staffing, executive level personnel, technical expertise and project management among others. The company, which began operations in 1997, is headquartered in Arlington, Virginia. STG International is underpinned by a strong mission to provide the highest quality of professional services to meet the evolving needs of its clientele in both public and private sectors, uniquely coupling innovative solutions with a client-focused approach.

Industry

Hospitals

Company size

1,001 - 5,000 Employees

Headquarters location

Arlington, VA, US

Year founded

1997

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