[Hiring] Director of Clinical Compliance Audits @PACS

Role Description

Reporting to the Senior Director of Clinical Compliance Investigations, the Director of Clinical Compliance Audits – PDPM is responsible for leading and coordinating the organization's PDPM audit program across skilled nursing facilities. This role oversees auditing activities related to Medicare reimbursement, MDS coding, clinical documentation integrity, and regulatory compliance, while supporting investigations and performance improvement initiatives designed to reduce organizational risk and promote accurate billing and documentation practices. This position will play a key role in advancing PACS' PDPM auditing capabilities and providing strategic oversight that enables leadership to focus on broader compliance priorities.

Key Responsibilities/Essential Duties

• Lead and coordinate PDPM audit activities across skilled nursing facilities to ensure accurate Medicare reimbursement, documentation integrity, coding accuracy, and regulatory compliance.
• Conduct routine and targeted audits related to billing and reimbursement practices, MDS coding, therapy utilization, clinical documentation, and quality outcomes.
• Support and participate in investigations involving clinical documentation, compliance concerns, and reimbursement-related processes.
• Analyze audit findings and trends to identify areas of risk and develop performance improvement initiatives that strengthen compliance and operational effectiveness.
• Partner with Clinical Operations, Risk Management, and facility leadership to implement corrective action plans and monitor ongoing compliance efforts.
• Provide guidance and subject matter expertise to audit team members and collaborate with operational and business support partners on education and compliance initiatives.

Qualifications

• 10+ years of experience in clinical practice and progressive regional MDS, compliance, or related healthcare auditing roles.
• Experience supporting multiple healthcare sites, preferably within skilled nursing facilities.
• Extensive experience conducting audits and investigations involving clinical documentation, regulatory compliance practices, Medicare and Medicaid reimbursement, and related operational processes.
• Demonstrated experience with PDPM reimbursement methodologies, Medicare billing, and MDS processes.
• Associate's or Bachelor's degree required.
• Active Registered Nurse (RN) license.
• RAC-CT and/or RAC-CTA certification required.

Requirements

• Ability to perform work in a primarily sedentary environment with extended periods of computer use.
• Ability to read, review, and analyze detailed documentation and audit materials.
• Regular use of hands for typing and operation of office equipment.
• Ability to communicate effectively in verbal and written formats.
• Occasional standing, walking, and light lifting (up to 10-20 pounds).
• Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the position.
• Less than 25% travel based on business needs.

Preferred Experience

• Master's degree.
• Experience leading large-scale compliance, audit, or investigative initiatives across multi-site healthcare organizations.

Required and Preferred Knowledge, Skills, and Abilities

• Deep understanding of Medicare and Medicaid documentation requirements, billing practices, PDPM reimbursement methodology, MDS coding, ICD-10 coding, and CMS regulations.
• Strong analytical and problem-solving skills with the ability to interpret complex audit findings and identify compliance risks.
• Ability to prioritize work effectively and execute in a fast-paced, dynamic environment.
• Exceptional attention to detail and commitment to audit quality.
• Excellent written and verbal communication skills.
• High level of integrity, professionalism, discretion, and confidentiality.
• Demonstrated commitment to ethical conduct, objectivity, and regulatory compliance.
• CHC (Certified in Healthcare Compliance) certification preferred.

Work Location

This position is fully remote and requires less than 25% travel based on business needs. Candidates may be located in any U.S. time zone, subject to business needs and approval.

Pay

The base salary for this position is $130,000-$145,000 based on experience and location.

Benefits

• 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 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.

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.