Clinical Compliance Auditor - Nurse

PACS; Salt Lake City (UT); Remote; USD 93,000 - 115,000; Full time

Benefits offered by this job

Health Coverage

PTO and Vacation

401(k) Plan

Job summary

PACS Group, Inc. is seeking an experienced Clinical Compliance Auditor II to perform comprehensive clinical audits, ensure CMS and state regulatory compliance, and promote accurate documentation and billing practices.

The role supports post-acute care operations with a focus on quality and compliance across sites. This is a remote role with less than 25% travel; candidates should have extensive Medicare/Medicaid experience and relevant certifications.

Qualifications

• Active nursing license (RN/LPN/LVN) and current licensure.
• Certificate in nursing or an associate degree required; bachelor’s preferred.
• 5+ years of leadership in compliance, specifically with MDS and reimbursement.
• Strong understanding of Medicare and Medicaid documentation, coding and regulations.
• AAPC/AHIMA/HCCA coding or auditing certifications preferred (CPC, CCS, CCS-P, COC, CPMA, CHC). RAC-CT preferred.

Responsibilities

• Complete internal audits related to billing and reimbursement accuracy, documentation integrity, therapy utilization and coding.
• Analyze audit findings to identify trends and root causes.
• Partner with operations to implement corrective action plans and follow-up.
• Conduct/combine on compliance investigations with timely, objective documentation.
• Deliver live and virtual trainings in collaboration with operations.
• Collaborate across functions including operations, finance, HR and IT.
• Provide regular updates and prepare audit reports.

Skills

RN/LPN/LVN license

5+ years leadership in compliance

Medicare/Medicaid documentation

Auditing/compliance certifications

Clinical auditing experience

Attention to detail

Communication skills

Education

Nursing certificate/associate degree

Bachelor’s degree preferred

Job description

COMPANY OVERVIEW

PACS Group, Inc. is a holding company investing in post-acute healthcare facilities, professionals, and ancillary services. Founded in 2013, PACS Group is one of the largest post-acute platforms in the United States. Its independent subsidiaries operate 400 post-acute care facilities with 50,000 employees across 17 states serving over 31,000 patients daily. PACS business support division, PACS Services, provides technology and administrative support services - accounting, finance, human resources, compliance, payroll, AR/AP, legal, risk management, information technology, corporate communication, and other business advice and support - to their healthcare facilities, reducing administrative burdens so their leadership and care teams can focus on the care, well-being, and quality of life of their patients and residents. PACS is one of Utah's Best Companies to work for. It has also been recognized as one of Utah's Fastest Growing Companies for multiple years.

JOB SUMMARY

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.

ESSENTIAL DUTIES

• 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 & EXPERIENCE

• 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.


• 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.

PAY

The range for this position is $93,000-$115,000 depending on experience, certifications and location.

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.

At PACS, we believe our employees are our greatest asset. That's why we offer an exceptional benefits package designed to enhance your well-being and support your lifestyle.

• Health Coverage: Enjoy medical, dental, and vision plans to keep you and your family healthy.


• PTO and Vacation: Benefit from generous paid time off and holidays to relax and recharge.


• Financial Wellness: Take advantage of Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) to manage your healthcare expenses effectively.


• Retirement Planning: Secure your future with our 401(k) plan, complete with company contributions to help you build your retirement savings.


• Support When You Need It: Our Employee Assistance Plan (EAP) provides confidential support for personal and professional challenges.

We celebrate diversity and are committed to creating an inclusive environment for all employees. We welcome applicants of every race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, and any other protected characteristic. Employment decisions are based on qualifications, merit, and business needs.