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Temp Part-time, Skilled Nursing Facility – Patient-Driven Payment Model
EXL. Perform quality reviews of completed SNF/PDPM audits to validate coding accuracy, reimbursement determinations, supporting documentation, and audit rationale .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in SNF/PDPM auditing, MDS 3.0 coding guidelines, and quality assurance processes while maintaining compliance with CMS regulations. Strong ability to analyze audit findings, identify trends, and provide constructive feedback to enhance quality and productivity.
Highest-signal resume keywords
Registered Nurse LicenseMDS 3.0 Coding GuidelinesPDPM Reimbursement MethodologyQuality AssuranceExcel Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
SNF Clinical ExperienceAuditingCompliance MonitoringHIPPS Code BillingQuality ReviewDocumentationProcess ImprovementRegulatory KnowledgeData AnalysisTrend Identification
Soft Skills
Detail OrientedExcellent Communication SkillsSelf-DirectedTeam CollaborationConstructive Feedback
Tools & Technologies
ExcelPowerPointOutlookWord3M Encoder Tools
Certifications & Qualifications
Registered Nurse LicenseLicensed Practical Nurse LicenseLicensed Vocational Nurse License
Industry Keywords
CMS GuidelinesRAI Manual RequirementsPDPM RegulationsMDS 3.0 RequirementsMedicare Local Coverage DeterminationsNational Coverage DeterminationsQuality ManagerAudit FindingsSNF Levels of CareQuality Processes
About the role
Key responsibilities & impact- Perform quality reviews of completed SNF/PDPM audits to validate coding accuracy, reimbursement determinations, supporting documentation, and audit rationale
- Ensure audit findings align with CMS guidelines, RAI Manual requirements, PDPM regulations, client requirements, and departmental procedures
- Document quality review findings clearly and accurately
- Identify quality trends, recurring audit errors, and opportunities for process improvement
- Provide constructive written feedback to auditors
- Achieve productivity and quality goals
- Respond timely to emails and meeting requests and attend scheduled meetings
- Participate in discussions and team meetings, providing improvement suggestions or volunteering when needed
- Adhere to EXL Health policies and procedures
- Report audit or quality-process problems to the Quality Manager for resolution
- Identify and communicate facility- and provider-specific issues affecting audits
- Maintain current knowledge of CMS regulations, PDPM reimbursement methodology, MDS 3.0 requirements, and industry best practices
- Monitor regulatory changes affecting SNF/PDPM auditing activities
Requirements
What you’ll need- Registered Nurse, Licensed Practical Nurse, or Licensed Vocational Nurse license in good standing in the state that you reside
- Minimum of 5 years’ experience with SNF clinical, MDS 3.0 completion, PDPM reimbursement methodology, quality assurance, auditing, and/or related experience
- Advanced knowledge of MDS 3.0 coding guidelines, skilled nursing facility (SNF) levels of care, and PDPM reimbursement
- Previous experience/exposure to the billing of HIPPS codes
- Experience reviewing audit findings, conducting quality revises, or performing compliance monitoring activities
- Experience with Excel, PowerPoint, Outlook, and Word
- Experience with Encoder tools such as 3M
- Experience with and expertise with Medicare Local Coverage Determinations (LCD) and National Coverage Determinations (NCD)
- Must be detail oriented
- Must have excellent verbal and written communication skills
- Must be self-directed and able to work with minimum oversight
Benefits
Comp & perks- Remote work flexibility
- Up to 10% annual travel for team meetings and limited client onsite engagements
- Opportunities for growth and mentorship through a structured coaching program
- Collaborative culture where ideas and insights are valued
- Opportunities for advancement
- Fast-paced, innovative environment with a team of driven professionals