Clinical Compliance Auditor II – PDPM

About the role

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 in Skilled Nursing Facilities and related post-acute care settings. This position promotes a strong, compliant, and values-aligned culture, 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 they are completed timely, objectively, and well-documented.
• Deliver live and virtual training sessions in collaboration with operations and clinical operations.
• Engage in cross-functional collaboration across the organization, including operations, clinical operations, finance, HR, and IT teams.
• Provide regular updates on investigation and audit results and prepare reports.
• Ensure compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommend opportunities to strengthen the internal control structure.

Requirements

• Active Nursing License (RN/LPN/LVN).
• Certificate in nursing or associate’s degree (required); bachelor’s degree (preferred).
• 5+ years of progressive leadership in compliance and/or skilled nursing facilities, specifically with MDS and reimbursement.
• Deep understanding and application of Medicare and Medicaid documentation, coding, and regulations.
• AAPC, AHIMA, or HCCA Coding certification and/or Auditing/Compliance certification (CPC, CCS, CCS-P, COC, CPMA, CHC) preferred; RAC-CT preferred.
• 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.

Expectations

• Ability to work independently with minimal supervision.
• Apply advanced knowledge and understanding of concepts, principles, and technical capabilities to manage audits and investigations.
• 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 (less than 25%).

Work Location

This role is remote.

Pay

Salary Range: $90,000 - $120,000 depending on experience.

About Us

PACS is elevating healthcare by revolutionizing our approach to leadership and quality care. Guided by our core values of love, excellence, trust, accountability, mutual respect, and commitment, we strive to foster a culture of compassionate care within our teams and the communities we serve. As we grow rapidly, exciting opportunities await you to engage in impactful projects and contribute valuable insights to stakeholders nationwide.

Benefits

• Health Coverage: Medical, dental, and vision plans.
• PTO and Vacation: Generous paid time off and holidays.
• Financial Wellness: Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA).
• Retirement Planning: 401(k) plan with company contributions.
• Support: Employee Assistance Plan (EAP) for confidential personal and professional support.