Clinical Compliance Auditor II – PDPM

PACS

1d•$90,000 - $120,000•Remote

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 Nursing (RN/LPN/LVN).
A certificate in nursing or associate’s degree, required.
5+ years of progressive leadership in compliance and/or skilled nursing facilities, specifically with MDS and reimbursement.
A 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.
Demonstrated regional and/or compliance oversight experience managing multiple healthcare sites.
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.
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

A bachelor’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.
Ensures compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommends opportunities to strengthen the internal control structure.