Medical Review Nurse - SNF/MDS Auditor

Responsibilities

• Document all findings referencing the appropriate policies and rules.
• Generate letters articulating audit findings.
• Support audit findings during the appeals process if requested.

Requirements

• Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise.
• requirements carefully. This role requires specific MDS experience, so if you do not have that
• Other duties as required to meet business needs.
• Experience with and deep knowledge of ICD-9, ICD-10, HCPCS coding.
• Knowledge of PDPM payment Items contributing to payment methodologies.
• Ability to manage multiple tasks including desk audits and claims review.
• Must be able to independently work within Microsoft Office products including Word, Excel, PPT, to Include creating/saving documents in folders, setting up and utilizing spreadsheets, copying and pasting data from one document to another.
• Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload.
• Active unrestricted RN license in good standing, is required.
• experience providing direct care in an inpatient or outpatient setting.
• One (1) or more years’ experience with MDS/ RAI process.
• experience in health care claims that demonstrates expertise in ICD-9/ICD-10 coding guidelines and how it relates to the MDS RAI Process.
• Strong preference for Understanding and in-depth comprehension of PDPM HIPPS codes including HIPPS Clinical Categories and the components that comprise the HIPPS categories.
• Knowledge of RUG and LOC commercial payors preferred but not required.
• Understanding of Medicare Benefit Payment Manual and Medicare Claims Processing Manual for SNF

Benefits