Clinical Compliance Auditor I - PDPM

About the role

Reporting to the Senior Director of Clinical Compliance Investigations, 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.

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.

Requirements

• Active License Nursing (RN/LPN/LVN).
• A certificate in nursing or associate’s degree, required.
• A bachelor’s degree, preferred.
• 3+ years of increasing levels of 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.
• A deep understanding and application of Medicare and Medicaid documentation, coding and regulations.
• RAC-CT preferred.
• 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.

What Is Expected Of You At This Level

• 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.

Physical demands

• Primarily sedentary role with extended periods of computer work.
• Occasional standing, walking, and light lifting (up to 10–20 lbs).
• Regular use of hands for typing and office equipment.
• Ability to read and review detailed documents.
• Clear verbal and written communication required.
• Occasional travel based on business needs.

Work location

This role is remote, requiring less than 25% travel. Preferred locations – Eastern or Central state location.