Clinical Compliance Auditor - Nurse

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 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. The role is remote, requiring less than 25% travel. The role is primarily sedentary with extended 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.

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.

Qualifications

• Active License Nursing (RN/LPN/LVN).
• A certificate in nursing or associate’s degree, required.
• A bachelor’s degree, preferred.
• 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.
• 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.
• 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 managing multiple healthcare sites.

Skills

• Strong analytical capabilities.
• Excellent communication.
• Attention to detail.
• Ability to work independently with minimal supervision.
• Ability to effectively prioritize and execute tasks in a fast‑paced, dynamic environment.
• Excellent time management.
• Personal integrity and ability to maintain confidentiality.
• Ability to apply advanced knowledge and understanding of concepts, principles, and technical capabilities to manage audits and investigations.

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 When You Need It: Employee Assistance Plan (EAP) for confidential support.

Pay

The range for this position is $93,000‑$115,000 depending on