Machinify - Medical Review Nurse - SNF/MDS Auditor

• Experience with and deep knowledge of ICD-9, ICD-10, HCPCS coding. • Knowledge of PDPM payment Items contributing to payment methodologies. • Ability to maintain high quality work while meeting strict deadlines. • Excellent written and verbal communication skills. • 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. • Effectively work independently and as a team, in a remote setting. • 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 that demonstrates expertise in ICD-9/ICD-10 coding guidelines and how it relates to the MDS RAI Process. • Comprehension of the Uniform Medical Billing Form (UB-04) and application to the MDS billing process. • Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions. • 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 • Equal Employment Opportunity at Machinify • We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/