About this opportunity
Peaks Healthcare lists this PDPM Skilled Specialists opportunity in denver, Colorado. Review the employer’s description below for duties, qualifications and application requirements.
Job description
PDPM Support Specialist
Why Join Our Team?
As a PDPM Support Specialist, you will play an important role in strengthening clinical documentation, regulatory compliance, reimbursement accuracy, and MDS performance across our skilled nursing facilities. This position provides an opportunity to partner directly with facility and regional leadership while helping clinical teams navigate the complexities of PDPM and Medicare reimbursement.
Multi-facility clinical and reimbursement support role
Opportunity to develop and educate MDS and interdisciplinary teams
Direct impact on documentation accuracy, compliance, and reimbursement integrity
Collaborative partnership with clinical, operational, and billing leadership
Opportunity to strengthen systems and processes across multiple facilities
Position Overview
We are seeking an experienced and detail-oriented PDPM Support Specialist to provide auditing, education, and operational support to our skilled nursing facilities.
The PDPM Support Specialist is responsible for reviewing skilled resident documentation and MDS-related processes to promote accurate Patient Driven Payment Model (PDPM) classification, appropriate reimbursement, and compliance with CMS requirements.
This position will work closely with MDS Coordinators, nursing leadership, interdisciplinary teams, billing personnel, facility Administrators, and regional leadership to identify documentation opportunities, address compliance concerns, provide education, and strengthen facility-level processes.
The successful candidate will possess a strong understanding of PDPM, the Resident Assessment Instrument (RAI), Medicare documentation, HIPPS coding, and skilled nursing reimbursement requirements.
Key Responsibilities
PDPM Auditing & Documentation Oversight
Conduct comprehensive audits of skilled resident records to evaluate documentation supporting PDPM classification and reimbursement
Review Medicare Part A and managed care resident records for documentation accuracy, completeness, and compliance
Evaluate clinical documentation supporting MDS coding and HIPPS code assignments
Identify documentation deficiencies, inconsistencies, and opportunities requiring additional review or clarification
Review supporting documentation for alignment with applicable CMS requirements and facility processes
Conduct audits designed to strengthen preparedness for Medicare Administrative Contractor (MAC) and Recovery Audit Contractor (RAC) review
Monitor trends in documentation, coding, and reimbursement practices across assigned facilities
Escalate identified compliance concerns, discrepancies, or potential fraud, waste, or abuse through appropriate organizational channels
MDS Support, Education & Development
Provide ongoing education to MDS Coordinators and interdisciplinary team members regarding PDPM documentation and CMS requirements
Provide timely, actionable feedback regarding PDPM capture opportunities, documentation deficiencies, and areas requiring improvement
Support MDS Coordinators in strengthening the accuracy and consistency of PDPM-related processes
Provide applicable PDPM section information to facility teams within established timeframes and follow up with leadership regarding utilization
Educate clinical and operational staff regarding documentation practices necessary to appropriately support resident acuity, services, and reimbursement
Assist facility teams in understanding the relationship between clinical documentation, MDS coding, PDPM classification, and reimbursement
Promote a culture centered on documentation integrity, regulatory compliance, and continuous improvement
Collaboration & Operational Support
Partner with facility leadership and interdisciplinary teams to promote complete and accurate documentation supporting PDPM reimbursement
Collaborate with the billing department to support timely completion of PDPM-related billing processes
Communicate audit findings, trends, identified risks, and improvement opportunities to facility and regional leadership
Follow up on identified deficiencies and support facilities in developing sustainable corrective processes
Serve as a resource to MDS Coordinators and facility leadership regarding PDPM-related questions and documentation practices
Maintain organized records of audits, findings, education, recommendations, and follow-up activities
Support consistency and accountability in PDPM processes across assigned facilities
Travel Requirements
This is a multi-facility support position requiring regular travel.
Travel to each assigned facility at least once per quarter
Consult on-site documentation and compliance audits
Provide in-person education, coaching, and support to MDS Coordinators and facility teams
Meet with facility leadership to review findings, trends, and opportunities for improvement
Travel by automobile or commercial air transportation as necessary based on assigned facility locations
Qualifications
Current Registered Nurse (RN) license preferred; Licensed Practical Nurse (LPN) license accepted
Compact nursing license required, or ability to obtain applicable licensure within one (1) month of hire
Minimum of one (1) year of experience with PDPM and skilled resident management
Working knowledge of the Resident Assessment Instrument (RAI) process
Strong understanding of PDPM methodology, CMS requirements, Medicare skilled services, and HIPPS coding
Skilled nursing facility documentation auditing experience strongly preferred
Experience supporting, educating, or mentoring MDS Coordinators preferred
RAC-CT certification preferred but not required
Ability to interpret and apply CMS requirements to facility-level documentation and reimbursement processes
Strong analytical and auditing skills with exceptional attention to detail
Excellent written and verbal communication skills with the ability to provide clear, constructive education and feedback
Strong organizational and time-management skills with the ability to manage multiple facilities, audits, deadlines, and competing priorities
Ability to work independently while maintaining effective communication with facility and regional leadership
Ability and willingness to travel regularly to assigned facilities
Compliance & Confidentiality
The PDPM Support Specialist is expected to maintain the highest standards of professional integrity and confidentiality.
All responsibilities must be performed in accordance with applicable:
CMS requirements and guidance
HIPAA privacy and security requirements
Federal and state healthcare regulations
Medicare and Medicaid program requirements
Organizational compliance policies and procedures
The PDPM Support Specialist is responsible for appropriately reporting identified compliance risks, documentation discrepancies, or suspected fraud, waste, or abuse through established organizational reporting channels.
Grow With Us
This position provides an opportunity to expand your expertise beyond individual facility MDS operations and contribute to clinical reimbursement performance across multiple skilled nursing facilities.
You will have the opportunity to develop MDS professionals, strengthen facility systems, collaborate with regional leadership, and help establish consistent standards for documentation integrity, regulatory compliance, and reimbursement accuracy.
Equal Opportunity Employer
We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to any protected characteristic in accordance with applicable federal, state, and local laws.
Reasonable Accommodation
We are committed to providing reasonable accommodations to qualified individuals with disabilities throughout the application and hiring process. Applicants requiring assistance should contact Human Resources.
Physical Requirements
Ability to sit and work at a computer for extended periods while reviewing clinical records and documentation
Ability to frequently review detailed electronic and written clinical information
Ability to lift and transport up to approximately 20 pounds of work-related equipment or materials as necessary
Ability to travel regularly by automobile or commercial air transportation
Ability to move throughout skilled nursing facilities while conducting on-site audits, observations, education, and meetings
Ability to perform the essential functions of the position with or without reasonable accommodation
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Worksite address
denver, CO, 80285, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.