Senior Compliance Specialist

Clinical Compliance SpecialistAre you ready to bridge the gap between clinical excellence and regulatory integrity? We are looking for a dynamic professional to champion our clinical compliance efforts. In this pivotal role you will ensure our clinical operations align with healthcare regulations and standards focusing on auditing medical necessity and documentation quality. This is more than just a specialist position; it is a career pathway to transition into Compliance. We are dedicated to developing our internal talent and this role is designed for a high-performing individual looking to grow into senior leadership within the department. You will gain exposure to high-level regulatory strategy risk assessment development and deployment and policy development setting the stage for professional advancement. The person who fills this role will have some chart review/auditing experience some experience working on special administrative projects like process improvement and a demonstrated willingness to learn and grow. While this role is compliance-focused we place a high premium on the clinical perspective. We are seeking a professional who understands the realities of patient care—specifically someone with a background in Nursing or Quality. While active clinical licensure is not a requirement having the "clinical eye" to interpret medical necessity and complex charting is a distinct advantage.Key ResponsibilitiesPerform comprehensive audits of medical records services to verify medical necessity and accurate documentation.Develop training and "tips" for clinical staff helping providers understand the "why" behind documentation standards.Serve as the subject matter expert on CMS updates the Two-Midnight Rule and coverage criteria.Identify documentation risks and collaborate with leadership to implement policies that enhance patient care quality.EducationBachelor's degree – preference for Healthcare Administration or a related clinical field.Nursing licensure preferred.ExperienceAt least 5 years of experience in a healthcare setting.Strong understanding of medical necessity criteria and charting standards.Excellent analytical skills with the ability to translate complex regulations into actionable training for providers.A background in clinical care Quality Assurance or Clinical Documentation Improvement (CDI) is highly advantageous.CredentialsCertification in Healthcare Compliance (CHC) or attained within 18 months of hire.