PDPM Support Specialist

Position Summary

The PDPM Support Specialist is responsible for auditing, monitoring, and supporting skilled nursing facility documentation and processes to ensure compliance with the Patient Driven Payment Model (PDPM). This role focuses on accurate coding, regulatory adherence, education of staff, and communication with facility leadership to optimize compliance and reimbursement while meeting CMS guidelines.

Essential Job Duties and Responsibilities

• Auditing and Documentation Oversight

  • Audit skilled residents’ charts to confirm accurate documentation supporting PDPM and CMS requirements.

  • Audit Medicare Part A (Med A) and managed care residents for accuracy and compliance.

  • Audit documentation supporting HIPPS code assignments.

  • Audit for MAC and RAC compliance to confirm documentation is accurate and error-free.

• Education and Feedback

  • Provide education to staff on best practices in accordance with CMS guidelines.

  • Provide timely feedback to staff and MDS coordinators on PDPM capture opportunities and deficiencies.

  • Provide PDPM section data in a timely manner to facilities and oversee managers to ensure utilization of the information.

  • Offer feedback and recommendations to MDS coordinators to strengthen PDPM accuracy.

  • Work closely with facility leadership to foster compliance-focused education and culture.

• Collaboration and Reporting

  • Partner with the billing department to ensure timely completion of billing processes related to PDPM.

  • Collaborate with interdisciplinary team members to ensure accurate documentation for PDPM reimbursement.

  • Provide ongoing communication to facility and regional leadership regarding audit results and trends.

• Travel

  • Required to travel to each facility at least once per quarter to conduct on-site audits, provide education, and review compliance processes.

Knowledge, Skills, and Experience Requirements

• Licensure/Education

  • RN license preferred; LPN license accepted.

  • Compact state license required or ability to obtain within 1 month of hire.

• Experience

  • Minimum of 1 year of experience in PDPM and skilled resident management.

  • Experience in auditing skilled nursing facility documentation preferred.

  • Experience in supporting and educating MDS coordinators preferred.

• Certification

  • RAC-CT certification preferred, but not required.

• Knowledge & Skills

  • Knowledge of RAI (Resident Assessment Instrument) process.

  • Strong understanding of PDPM, CMS guidelines, HIPPS codes, and compliance requirements.

  • Proficient written and verbal communication skills with ability to provide clear education and feedback.

  • Strong organizational skills and ability to manage multiple audits across multiple facilities.

  • Ability to interpret and apply CMS regulations to facility-level documentation.

Physical Requirements

• Ability to sit for extended periods while auditing records.

• Ability to lift up to 20 lbs occasionally (records, laptop, files).

• Must be able to travel to assigned facilities by car or plane.

• Visual acuity to review detailed documentation and data.

All work must be performed in compliance with HIPAA, CMS, state Department of Health regulations, and facility compliance programs. The PDPM Support Specialist is responsible for reporting any identified compliance risks, discrepancies, or potential fraud/waste/abuse through appropriate channels.