Skilled Nursing Facility Auditor

Job Summary

A company is looking for an Auditor III - SNF/RUG.

Key Responsibilities

• Conduct clinical reviews to verify the accuracy of skilled nursing facility billing
• Apply CMS clinical guidelines and payer-provider contract terms to identify overpayments
• Document audit results clearly and utilize proprietary workflow systems for audit determinations

Required Qualifications

• LPN or Registered Nurse with an Associate's or Bachelor's degree preferred
• 3+ years of skilled nursing experience, with preference for RAC certification or MDS coordinator experience
• Experience with RUG and PDPM Medicare reimbursement systems and Medicaid 48 grouper reimbursement system
• Familiarity with billing of HIPPS codes and days of billing for each assessment type