Clinical Compliance Auditor I - PDPM

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 325 post-acute care facilities with 47,000 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 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. 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. 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. Join PACS: Elevate Healthcare with 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. If you're ready to make a difference and embrace our mission of creating real change, we invite you to join us at PACS. Together, let’s shape the future of healthcare! Join Our Team and Thrive! 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. Our Comprehensive Benefits Include 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. Join us at PACS and take advantage of a workplace that truly values you! 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.