Clinical Compliance Auditor II – Behavioral Health
About The Position
Reporting to the Senior Director of Clinical Audit, the Clinical Compliance Auditor II is an advanced-level compliance professional responsible for conducting comprehensive clinical audits of clinical documentation, regulatory compliance practices, and reimbursement related processes related to Skilled Nursing Facilities and related post‑acute care settings. This position will promote strong, compliant, and values‑aligned culture. The role ensures adherence to federal, state, and local regulations including CMS requirements, supports quality improvement initiatives, and promotes accurate clinical documentation and billing practices.
Requirements
- Active License in Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), or Nursing (RN) or related clinical discipline.
- A bachelor’s degree, required.
- 5+ years of increasing levels of responsibility in compliance and/or skilled nursing facilities, specifically with behavioral health auditing.
- A deep understanding and application of Medicare and Medicaid documentation, coding and regulations.
- Prior experience conducting audits and or conducting internal investigations, in a healthcare setting.
- Ensures compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommends opportunities to strengthen the internal control structure.
- Demonstrated regional and/or compliance oversight experience supporting multiple healthcare sites.
- Strong analytical capabilities, excellent communication, attention to detail, and ability to work in a dynamic, fast-paced setting.
- Ability to carry out responsibilities with minimal supervision.
- Apply advanced knowledge and understanding of concepts, principles, and technical capabilities to manage audits and investigations.
- Possesses strong attention to detail.
- Ability to effectively prioritize and execute tasks in a fast‑paced, dynamic environment.
- Excellent time management, personal integrity and ability to maintain confidentiality.
Nice To Haves
- Master’s degree, preferred.
- AAPC, AHIMA or HCCA Coding certification and or Auditing/Compliance certification (CPC, CCS, CCS‑P, COC, CPMA, CHC) preferred.
- RAC-CT preferred.
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 completed timely, objectively and well documented.
- Deliver live and virtual training sessions in collaboration with operations and clinical operations.
- Cross functional collaboration across the organization, including (but not limited to) 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)
- Flexible Spending Accounts (FSA)
- 401(k) plan, complete with company contributions
- Employee Assistance Plan (EAP)
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
