Lead Clinical Compliance Auditor

Description

JOB DESCRIPTION

Lead Clinical Compliance Auditor

The Center for Elders’ Independence is a PACE (Program of All-Inclusive Care for the elderly) organization (PO) that uses an interdisciplinary team approach for care planning and implementing purposeful high quality, affordable, and integrated health care services to the elderly. Our elderly meet PACE requirements as prescribed by CMS and are referred to as participants. Our PO includes Adult Day Health Centers and primary care clinics, promoting participant autonomy, quality of life and the ability for individuals to live in their communities

THE POSITION: The Lead Clinical Compliance Auditor plays a key role in ensuring the accuracy, completeness, and regulatory compliance of participant medical records for CEI. This position supports high‑quality, coordinated care by reviewing clinical documentation across interdisciplinary teams and identifying opportunities to strengthen documentation practices, regulatory adherence, and audit readiness. The Lead Clinical Compliance Auditor works closely with clinical, quality, and compliance staff to promote consistent, accurate, and timely charting that reflects the care delivered to CEI participants.

The rate range for the Lead Clinical Compliance Auditor position at Center For Elders Independence is $86,095to $129,143per yr.  Hourly rate based on the market for the Lead Clinical Compliance Auditor position, as well as experience, skills, abilities and work history.

DUTIES AND RESPONSIBILITIES:

• Serve as the lead resource and subject‑matter expert for clinical documentation standards, PACE regulatory requirements, and audit methodology.
• Develop and refine audit tools, scoring criteria, and workflows to improve consistency and effectiveness
• Perform routine, targeted, and retrospective audits of participant medical charts across all clinical disciplines.
• Review documentation for accuracy, completeness, timeliness, and adherence to CMS, DHCS, state, and organizational standards.
• Verify that assessments, care plans, progress notes, orders, and interdisciplinary updates meet internal standards and regulatory expectations.
• Identify documentation deficiencies, inconsistencies, or omissions and communicate findings to appropriate staff for correction
• Monitor documentation practices to ensure compliance with CMS PACE regulations, state requirements, and organizational policies.
• Assist in preparing for internal and external audits, including CMS and DHCS reviews.
• Track trends in documentation deficiencies and escalate systemic issues to Senior Director of Quality and Compliance.
• Provide feedback, coaching, and training to staff on documentation standards, common errors, and opportunities for improvement.
• Collaborate with interdisciplinary teams to reinforce timely and accurate documentation workflows.
• Prepare reports summarizing audit outcomes, trends, and recommendations for leadership.
• Support quality improvement initiatives by identifying documentation‑related risks and contributing to corrective action planning.

QUALIFICATIONS:

• Bachelor’s degree in Nursing, Social Work, Physical Therapy, or a related clinical field required; a master’s degree in Nursing, Social Work, or a Doctor of Physical Therapy (DPT) is preferred.
• Advanced experience in medical chart auditing, health information management, or clinical documentation review, preferably in a lead or senior capacity.
• Strong understanding of medical terminology, interdisciplinary care documentation, and healthcare regulatory standards.
• Experience with PACE, long‑term care, or similar regulated healthcare environments.
• Excellent attention to detail, analytical skills, and written communication abilities.
• Proficiency with electronic health record (EHR) systems and Microsoft Office Suite.
• Ability to manage multiple priorities, meet deadlines, and communicate effectively with staff at all levels

The above job description is intended to communicate the general function of the mentioned position and by no means shall be considered an exhaustive or complete outline of the specific tasks and functions that will be required. CEI reserves the right to change job descriptions, site assignments, and or work hours as required by the needs of the program. All employees are expected to perform their duties within their ability as required by the job and/or as requested by management.

Center for Elders’ Independence is a PACE (Program of All- Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, including an Adult Day Health Center, and promoting autonomy, quality of life and the ability of individuals to live in their communities. Unlike other healthcare plans, CEI is not a "fee-for-service" plan. It is a “capitation” healthcare plan. CEI is paid a set amount for each person enrolled in our program, whether or not that individual seeks care. We are a growing company that offers stability and continues to thrive.