Clinical Compliance Coordinator

Job Description

Job Description

Job Description Summary

The Clinical Compliance Coordinator (LVN) is responsible for supporting the organization?s Quality Assurance and Performance Improvement (QAPI) program and ensuring the quality, accuracy, completeness, and timeliness of clinical documentation. This position conducts comprehensive medical-record reviews and audits to evaluate compliance with organizational policies, Medicare requirements, applicable federal and state regulations, and established clinical standards.

The Clinical Compliance Coordinator works closely with the Director of Patient Care Services, clinical leadership, and the interdisciplinary care team to identify documentation deficiencies, monitor quality indicators, support corrective actions, and promote continuous improvement in the delivery of patient care.

Essential Duties and Responsibilities

• Review patient medical records and clinical documentation to evaluate the quality, accuracy, completeness, consistency, and timeliness of services provided.

• Conduct routine and focused medical-record and clinical documentation audits to ensure compliance with agency policies, Medicare requirements, applicable laws, regulations, and accreditation standards.

• Review nursing and other clinical documentation to ensure that notes are accurate, detailed, clinically appropriate, and completed within required timeframes.

• Monitor documentation for compliance with applicable Medicare Conditions of Participation (CoPs), state regulations, payer requirements, and organizational standards.

• Develop, implement, and complete Quality Assurance and Performance Improvement (QAPI) audits and other quality-monitoring activities.

• Identify documentation deficiencies, compliance risks, trends, and opportunities for improvement and communicate findings to appropriate clinical leadership.

• Collaborate with the Director of Patient Care Services and clinical management to resolve documentation discrepancies and implement appropriate corrective actions.

• Work collaboratively with the interdisciplinary care plan team to evaluate the quality and appropriateness of patient care and supporting documentation.

• Review plans of care, assessments, physician orders, visit documentation, and other clinical records for consistency and regulatory compliance.

• Assist with monitoring administrative and clinical claims documentation to support accurate, compliant reimbursement.

• Maintain current knowledge of Medicare/CMS requirements, state regulations, QAPI standards, accreditation requirements, and applicable healthcare laws.

• Support regulatory and accreditation readiness activities, including internal audits, mock surveys, corrective action plans, and follow-up monitoring.

• Track audit findings and quality indicators and assist with identifying trends requiring performance improvement.

• Provide feedback and education to clinical staff regarding documentation standards, compliance requirements, and quality improvement opportunities.

• Participate in in-services, staff meetings, case conferences, QAPI meetings, and quality improvement activities as required.

• Maintain accurate audit records, reports, compliance documentation, and quality-improvement data.

• Promote a culture of accountability, patient safety, regulatory compliance, and continuous quality improvement.

• Perform other duties and responsibilities as assigned that are consistent with the position and organizational needs.

Qualifications and Requirements

• Current, unrestricted California Licensed Vocational Nurse (LVN) license.

• Graduate of an accredited vocational/practical nursing program.

• Minimum of two (2) years of licensed nursing experience, with at least one (1) year of home health experience preferred/required.

• Previous experience in quality assurance, clinical compliance, QAPI, chart auditing, utilization review, or clinical documentation review strongly preferred.

• Working knowledge of Medicare/CMS Conditions of Participation, California regulations, and home health documentation requirements.

• Familiarity with clinical documentation, medical-record auditing, quality improvement principles, and regulatory compliance.

• Strong computer skills and ability to work effectively with electronic medical record (EMR/EHR) systems.

• Excellent attention to detail with the ability to identify documentation discrepancies, compliance gaps, and quality trends.

• Strong analytical, organizational, time-management, and problem-solving skills.

• Excellent written and verbal communication skills.

• Ability to work independently while effectively collaborating with clinical leadership and interdisciplinary teams.

• Ability to maintain confidentiality and comply with HIPAA and applicable privacy requirements.

Preferred Qualifications

• Experience with home health QAPI programs.

• Experience reviewing OASIS assessments, Plans of Care, physician orders, visit documentation, and recertification/discharge documentation.

• Familiarity with Medicare billing and documentation requirements.

• Experience with regulatory surveys, accreditation preparation, mock audits, and corrective action plans.

• Experience with home health EMR platforms such as WellSky/Kinnser or similar systems.

Compensation

Pay Range: $35.00?$45.00 per hour, depending on qualifications, experience, and applicable organizational compensation guidelines.

Benefits:

• 401(k)
• Health insurance
• Paid time off
• Vision insurance
• Dental insurance