Curana Health is a leader in value-based primary care for senior living, offering tailored care models to skilled nursing facilities, assisted & independent living communities, Memory Care units, and affordable senior housing. With over 1,000 clinicians serving more than 1,500 senior living partners across 33 states, Curana Health is at the forefront of transforming care delivery for high-risk seniors. Our goal: to radically enhance the health, happiness, and dignity of senior living residents.
Position Summary:
We are seeking a Clinical Compliance Auditor who is a Nurse Practitioner (NP) to join our Compliance team. This role ensures adherence to compliance programs, manages audits and investigations, and upholds the integrity of our clinical practices in line with regulatory standards. The Clinical Compliance Auditor will perform due diligence, identify potential Fraud, Waste, and Abuse (FWA) issues, and provide guidance on compliance improvements.
Key Responsibilities:
- Audit and Compliance Oversight:
- Conduct audits on clinical documentation, coding, and billing practices to ensure compliance with CMS regulations and Curana Health policies.
- Identify and address potential FWA (Fraud, Waste, and Abuse) risks through thorough investigations and data analysis.
- Due Diligence and Investigations:
- Lead and participate in compliance investigations related to clinical practices and coding accuracy.
- Coordinate with internal teams and external partners on due diligence processes for new acquisitions or partnerships.
- Coding and Documentation Review:
- Provide expert guidance on accurate coding practices, collaborating with clinicians to improve documentation that supports compliant billing and care delivery.
- Review coding patterns for consistency and compliance, ensuring proper reimbursement aligned with clinical services rendered.
- Compliance Program Support:
- Assist in the development, implementation, and maintenance of Curana Health’s compliance programs.
- Educate and train clinicians and support staff on compliance policies, coding accuracy, and documentation standards.
- Quality Improvement:
- Partner with Quality and Clinical teams to identify areas for improvement, contributing to high standards of care and compliance across Curana Health’s service lines.
- Document findings from audits and create reports with actionable recommendations.
Qualifications:
- Active Nurse Practitioner (NP) license.
- 2+ years demonstrated experience as a Nurse Practitioner providing primary care, geriatric, or senior living services.
- Experience in senior care, skilled nursing facilities, or similar settings.
- Certified Medical Coder (CPC, CCS, or equivalent) or willingness to obtain certification once hired.
- Excellent communication skills with the ability to collaborate cross-functionally and educate clinical staff on compliance matters.
Preferred Skills:
- Familiarity with Accountable Care Organizations (ACO), Medicare Advantage, or other CMS value-based care programs.
- Proficiency in compliance software and documentation review systems.
- Experience in healthcare compliance, coding, and auditing, ideally in value-based primary care or senior care settings.
- Background in FWA investigations and regulatory compliance within healthcare.
- Strong understanding of CMS regulations, coding practices, and compliance standards.
Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances.
The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment.
*The company is unable to provide sponsorship for a visa at this time (H1B or otherwise).
