Clinical Compliance Auditor I - PDPM

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 settin...