Compliance Clinical Auditor I - Therapy

PACS

5d•Remote

About The Position

The Clinical Compliance Auditor I is responsible for conducting routine audits of clinical documentation, regulatory compliance practices, and reimbursement related processes related to Skilled Nursing Facilities. This 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) or Occupational Therapy (OT).
Bachelor’s degree required.
3+ years of increasing levels of responsibility in compliance and/or skilled nursing facilities. Specifically regional therapy services and or dedicated compliance roles, with oversight experience supporting multiple healthcare sites.
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.
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 knowledge and understanding of concepts, principles, and technical capabilities to manage audits and investigations.
Ability to effectively prioritize and execute tasks in a fast‑paced, dynamic environment.
Excellent time management, personal integrity and ability to maintain confidentiality.
Effective written and verbal communication.

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.