Compliance Clinical Audit Specialist

Majestic Care -

Majestic Care Staffing is looking for Compliance Clinical Audit Specialist to join our teams’ mission and believe in our core values!

Our mission :   Through the hearts of our Care Team Members, we provide excellent healthcare to those we serve.

Our Core Values...

L - Listening

E - Empathy

A - Accountability

D - Decisiveness

This is how we create a culture to LEAD with Love.

Through the hearts and minds of our care team members, we provide excellent healthcare to those we serve. With a vision of innovating healthcare by keeping those we serve at the heart of our mission, we provide tools, processes, support resources, data analytics, and insource strategies that drive results.

Position Overview :

The Corporate Compliance Clinical Audit Specialist  is a key member of the Corporate Compliance & Ethics team. This position audits post-acute care facilities to assess adherence to the Office of Inspector General’s (OIG) compliance program requirements for skilled nursing facilities, home health, and hospice. The role involves conducting facility reviews, identifying compliance gaps, and supporting the implementation of best practices aligned with industry standards and organizational policies.

Key Responsibilities :

Responsible for the development and implement new care team member orientation training programs related to PCC

Creates and delivers intermittent re-training plans for clinical care team members as needed

Facilitates on-site support programs and troubleshoot internal user questions / problems as they arise.

Responsible for keeping abreast of all releases of PCC system and manages all communication to any impact to users.

Maintains oversight by monitoring the PCC environments to ensure integrity of data.

Extract data / reports for Senior Leadership and Leadership within our communities upon request.

Serves as a liaison for all PCC integrations for new acquisitions.

Essential Job Functions :

Compliance Auditing and Oversight

Conduct retrospective, concurrent, and prospective audits of medical records across skilled nursing, home health, and hospice settings to assess compliance with billing, coding, documentation, and quality standards.

Identify discrepancies, errors, or potential non-compliance with federal / state regulations, payer requirements, and internal policies.

Lead and manage internal compliance audits, ensuring timely completion, accurate documentation, and development of corrective action plans.

Track audit outcomes and collaborate with stakeholders to implement monitoring strategies that support sustained compliance.

Audit Response and Denials Support

Support pre- and post-payment audit responses by coordinating documentation, tracking deadlines, and communicating with payers as directed.

Assist in managing denial responses, including gathering supporting documentation and contributing to appeal strategies.

Coordinate responses to external audit requests and ensure timely, accurate submissions.

Training and Education

Deliver post-audit training sessions tailored to audit findings, focusing on documentation, coding, billing, and regulatory compliance.

Develop and present educational materials to care team members on compliance best practices and regulatory updates.

Investigations and Policy Development

Participate in investigations of potential compliance concerns and evaluate opportunities for proactive auditing.

Contribute to the review and enhancement of organizational policies and procedures to improve compliance and operational efficiency .

Collaboration and Reporting

Prepare and present audit and investigation findings to leadership, including recommendations for corrective actions and process improvements.

Collaborate with departments such as Legal, Clinical, IT, Finance, MDS / RAI, Operations, and HR to address compliance issues and implement solutions.

Maintain accurate records of audit activities and ensure alignment with HIPAA and regulatory standards.

Regulatory Awareness and Support

Stay informed on changes in CMS, Managed Care, and other regulatory agency guidelines.

Provide support for compliance initiatives and special projects as needed across the organization .

Education

• Bachelor’s degree required; equivalent work experience may be considered.

Licenses and Certifications

Active clinical license (RN, LPN, PT / OT / ST, etc)

Certified in Healthcare Compliance (must be obtained within one year of hire).

Coding credentials (must be obtained within one year of hire).

Experience

Strong operations background

Compliance or healthcare / post-acute care experience, including billing, coding, or documentation (HIM)

Experience conducting compliance audits in clinical or administrative settings

Proficiency with electronic health records (EHRs) and healthcare documentation systems

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