Senior Director – Clinical Compliance Audit

General Purpose

Reporting to the SVP, Associate Chief Compliance Officer of Audit, the Sr.

Director of Clinical Compliance Audit serves as a subject matter expert of clinical compliance, reimbursement integrity and education.

This newly created position partners closely with the compliance leadership team, business operations, clinical operations, and finance.

This position will promote strong, compliant, and values-aligned culture.

The role requires a seasoned compliance professional with extensive experience with internal clinical audits, investigations and education with deep knowledge in Skilled Nursing Facilities and related post-acute care settings.

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, root causes and systemic risks.


* 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.


* Work with the compliance leadership team to operationalize training initiatives and develop training programs.


* Deliver live and virtual training sessions in collaboration with operations and clinical operations.


* Track training completion metrics and measure effectiveness through assessments and trend analysis.


* 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.

WHAT IS EXPECTED OF YOU AT THIS LEVEL


* Supervises audit staff, collaborates with operations and other business support staff.


* Applies advanced knowledge and understanding of concepts, principles, and technical capabilities to manage audits, investigations and education initiatives.


* 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.

Qualifications


* Licensed in Physical Therapy, Occupational Therapy, Speech Language Pathology, or Nursing.


* A bachelor's degree, required.

master's degree, preferred.


* 6+ years of progressive leadership in compliance and skilled nursing facilities, understanding of CMS Conditions of Participation and OIG guidance.


* AAPC, AHIMA or HCCA Coding certification and or Auditing/Compliance certification (CPC, CCS, CCS-P, COC, CPMA, CHC) preferred.


* Prior experience leading compliance audits and conducting internal investigations, in a healthcare setting.


* Ensures compliance with regulations and controls by examining and analyzing records, reports, operating practices, and do...