Clinical Compliance Auditor I - PDPM
About The Position
The Clinical Compliance Auditor I reports to the Senior Director of Clinical Compliance Investigations and conducts routine audits of clinical documentation, regulatory compliance practices, and reimbursement-related processes for Skilled Nursing Facilities. The role supports adherence to federal, state, and local regulations, including CMS requirements, and promotes quality improvement, accurate clinical documentation, and billing practices. The auditor analyzes findings for trends and root causes, works with operations and clinical operations on corrective action plans and follow-up, and conducts or supports timely, objective, well-documented compliance investigations. The role also delivers live and virtual training, collaborates across organizational functions, and prepares reports and updates on audit and investigation results. This is a remote role requiring less than 25% travel, with preferred locations in Eastern or Central states. The work is primarily sedentary and involves extended computer use, detailed document review, and occasional standing, walking, and light lifting.
Requirements
- Active nursing license (RN/LPN/LVN).
- A nursing certificate or associate degree is required.
- At least 3 years of increasing responsibility in compliance and/or skilled nursing facilities, specifically in a regional MDS role and/or dedicated compliance roles, with oversight experience supporting multiple healthcare sites.
- Deep understanding and application of Medicare and Medicaid documentation, coding, and regulations.
- Prior experience with clinical auditing and conducting internal investigations in a healthcare setting.
- Strong analytical capabilities, excellent communication, attention to detail, and ability to work in a dynamic, fast-paced setting.
- Ability to work independently with minimal supervision.
- Ability to apply advanced knowledge and understanding of concepts, principles, and technical capabilities to manage audits and investigations.
- Ability to prioritize and execute tasks effectively in a fast-paced, dynamic environment.
- Excellent time management, personal integrity, and ability to maintain confidentiality.
- Clear verbal and written communication skills.
Nice To Haves
- Bachelor's degree.
- RAC-CT certification.
Responsibilities
- Complete internal audits related to billing and reimbursement accuracy, documentation integrity, therapy utilization and coding, quality, and clinical documentation.
- Analyze audit findings to identify trends and root causes.
- Partner with operations and clinical operations to implement corrective action plans and ensure timely follow-up.
- Conduct and/or partner on compliance investigations, ensuring they are completed timely, objectively, and with adequate documentation.
- Deliver live and virtual training sessions in collaboration with operations and clinical operations.
- Collaborate across the organization, including with operations, clinical operations, finance, HR, and IT teams.
- Provide regular updates on investigation and audit results and prepare reports.
Benefits
- Medical, dental, and vision plans.
- Generous paid time off and holidays.
- Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA).
- 401(k) plan with company contributions.
- Employee Assistance Plan (EAP) providing confidential support.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
