LPN/RN Skilled Nursing Auditor

Job Summary

A company is looking for a Skilled Nursing Facility (SNF) Auditor III.

Key Responsibilities

• Conduct in-depth clinical reviews to verify SNF billing accuracy
• Analyze claims under PDPM, RUG, and per diem payment models to identify overpayments
• Document audit findings using tools and guidelines while staying updated on clinical regulations

Required Qualifications

• LPN or RN with an Associate's or Bachelor's degree preferred
• 3+ years of skilled nursing experience, with RAC certification or MDS coordinator experience as a plus
• Familiarity with PDPM, RUG, Medicaid 48 grouper reimbursement, and HIPPS codes billing