Majestic Care · 3 weeks ago
Corporate Compliance Clinical Auditor
Westfield, IN
Full-time
Onsite
Mid Level
3+ years expMajestic Care Staffing is dedicated to providing excellent healthcare and is seeking a Corporate Compliance Clinical Auditor. This role involves auditing post-acute care facilities to ensure adherence to compliance program requirements and supporting the implementation of best practices aligned with industry standards.
Health CareHealth InsuranceHome Health CarePersonal Health
Responsibilities
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
Support pre- and post-payment audit responses by coordinating documentation, tracking deadlines, and communicating with payers as directed
Collaborate with clinical, billing, and operational teams to gather required documentation
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
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
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
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
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
Qualification
Required
Bachelor's degree required; equivalent work experience may be considered
Active clinical license (RN, LPN, PT/OT/ST, etc)
Certified in Healthcare Compliance (must be obtained within one year of hire)
3 years of experience in Medicaid, Medicare, & Managed Care ADRs, Audits, & Denials
Compliance/Healthcare post-acute care experience, including billing, coding, and documentation
Experience with Medicare A/B, Medicare Advantage, and Medicaid (multi-state) coverage criteria, Medicare billing rules, along with documentation standards
Proficiency with electronic health records (PCC) and healthcare documentation systems
Strong understanding of healthcare regulations, compliance standards, and audit processes
Strong knowledge of MDS, PDPM, and documentation requirements
Excellent analytical and problem-solving skills with attention to detail and accuracy
Effective communication and interpersonal skills across multidisciplinary teams
Ability to work independently and collaboratively in a fast-paced environment
Skilled in managing multiple priorities and meeting deadlines with minimal supervision
Strong organizational, planning, and project management abilities
Ability to build and maintain professional relationships across departments
High level of discretion and ability to handle sensitive and confidential information
Expert-level proficiency in Microsoft Office 365 Suite (Teams, SharePoint, Excel, etc.)
Demonstrated ability to remain composed and effective in high-pressure situations
Proactive, resourceful, and solutions-oriented with a focus on continuous improvement
Preferred
Certifications (RAC-CT, RAC-CTA) preferred
Company
Majestic Care
Majestic Care is a health care centre specialized in community based skilled nursing throughout clinical services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Paul Pruitt, MBA, NHA
Chief Executive Officer
Donn Kump
Chief Financial Officer
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