Medical Review Nurse II – SNF/MDS Auditor

Machinify

. Audit claims for medically appropriate services provided in skilled nursing facility settings, applying medical review guidelines, policies, and rules .

Posted 10/26/2026full-timeRemote • United StatesMid-LevelSenior💰 $90,000 - $105,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in auditing claims for medically appropriate services in skilled nursing facilities, applying medical review guidelines and coding standards. Proficient in managing audit processes, collaborating with teams, and maintaining compliance with regulatory requirements.

Highest-signal resume keywords

Active RN LicenseICD-9/ICD-10 Coding ExpertiseMDS/RAI Process ExperienceMedical Records Review ExperienceExcellent Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Review GuidelinesClaims AuditingICD-9 CodingICD-10 CodingHCPCS CodingUniform Medical Billing Form (UB-04)PDPM Payment MethodologiesMDS Billing ProcessQuality Assurance FunctionsAudit Workflow Improvements

Soft Skills

Organizational SkillsTeam CollaborationIndependent WorkTime ManagementAttention to Detail

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft PowerPoint

Certifications & Qualifications

Active RN License

Industry Keywords

Skilled Nursing FacilityHealthcare ClaimsRegulatory ComplianceAudit FindingsProvider Education

About the role

Key responsibilities & impact

Audit claims for medically appropriate services provided in skilled nursing facility settings, applying medical review guidelines, policies, and rules
Document audit findings with references to appropriate policies and rules
Generate letters articulating audit findings
Support audit findings during the appeals process when requested
Collaborate with the audit team to identify and obtain approval for vulnerabilities and potential abuse cases
Partner with clients, CMD colleagues, and contractors to improve medical policies, provider education, and system edits
Monitor medical practice, technology changes, and regulatory issues affecting clients
Help minimize appeals and suggest audit workflow improvements
Assist with QA functions and train team members
Participate in establishing edit parameters, new issue packets, and Medical Review Guidelines
Interface with and support the Medical Director and cross-train across clinical departments
Perform other duties as required to meet business needs

Requirements

What you’ll need

Active unrestricted RN license in good standing is required
Must not be currently sanctioned or excluded from the Medicare program by the OIG
Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting
One (1) or more years’ experience with MDS/RAI process
One (1) or more years' experience performing medical records review
One (1) or more years' experience in health care claims demonstrating expertise in ICD-9/ICD-10 coding guidelines and their relation to the MDS RAI Process
Comprehension of the Uniform Medical Billing Form (UB-04) and application to the MDS billing process
Experience with and deep knowledge of ICD-9, ICD-10, and HCPCS coding
Knowledge of PDPM payment items contributing to payment methodologies
Ability to work independently with Microsoft Office products including Word, Excel, and PowerPoint
Ability to manage multiple assignments, document findings, and organize and prioritize workload
Ability to work independently and as part of a team in a remote setting
Ability to maintain high-quality work while meeting strict deadlines
Excellent written and verbal communication skills