Overview

PMTAC is seeking an experienced SNF Medicare Billing Specialist with strong knowledge of the Patient-Driven Payment Model (PDPM) and Skilled Nursing Facility (SNF) Medicare Part A billing requirements. The ideal candidate will have hands-on experience with MDS-driven reimbursement, HIPPS coding, and UB-04 claim submission. This role requires a strong understanding of Centers for Medicare & Medicaid Services (CMS) billing guidelines and compliance regulations.

Responsibilities

• Medicare Eligibility Verification
• Verify Medicare Part A coverage for SNF residents.
• Confirm qualifying 3-day hospital stay and benefit period.
• Review secondary insurance coverage (Medicaid, Medicare Advantage, commercial payers).
• MDS & PDPM Coordination
• Review and ensure accurate completion of Minimum Data Set (MDS) assessments.
• Validate:
• Clinical conditions
• Functional status