Regulatory Compliance Specialist

Description

The Regulatory Compliance Specialist plays a critical role in ensuring Behavioral Health Allies (BHA) operates in full compliance with applicable federal, state, and local laws, regulations, accreditation standards, and contractual requirements, with a specific emphasis on Kansas and Missouri regulatory frameworks. Working closely with the Director of Safety, Risk and Compliance, this position supports the development, implementation, monitoring, and continuous improvement of BHA’s compliance, privacy, and risk management programs.

This role supports compliance with oversight agencies including, but not limited to, the Kansas Department of Children and Families, Missouri Department of Mental Health, Missouri Department of Social Services, Missouri Department of Elementary and Secondary Education and Centers for Medicare & Medicaid Services, and applicable Medicaid Managed Care Organizations. Responsibilities include conducting internal reviews and audits, tracking regulatory changes, assisting with enterprise-wide risk assessments, supporting external surveys and third-party audits, and maintaining accurate compliance documentation.

The Regulatory Compliance Specialist serves as a key partner to cross-functional teams, helping translate regulatory and contractual requirements into practical, workable policies and procedures that support safe, ethical, and high-quality services for individuals with developmental disabilities and complex behavioral needs, while reinforcing adherence to BHA’s mission and core values.

KEY RESPONSIBILITIES:

Audit, Compliance, and Risk Management 

· Assist the Director of Safety, Risk and Compliance with internal reviews, audits, and compliance assessments to verify adherence to applicable federal and state laws, CMS Conditions of Participation, Medicaid waiver requirements, state plan services, accreditation standards, payer contracts, and organizational policies. 

· Support compliance monitoring related to Kansas and Missouri Medicaid programs, including HCBS waivers, MCO requirements, and state-specific provider manuals and regulations. 

· Identify, document, and organize compliance findings, trends, and potential risk areas; assist in developing and tracking corrective action plans, plans of correction (POCs), and quality improvement initiatives. 

· Verify compliance with insurer rules, Medicare, Medicaid, HIPAA, and applicable Kansas and Missouri statutes, administrative regulations, and DMH/KDADS requirements. 

· Assist in conducting enterprise-wide risk assessments, including identification of operational, regulatory, privacy, and compliance risks. 

· Support preparation for, participation in, and follow-up from third-party audits, surveys, licensing reviews, and regulatory inquiries.

Policy Development and Document Control 

· Assist with the development, review, implementation, and revision of policies, procedures, and compliance-related documents based on regulatory changes and organizational needs. 

· Coordinate with departments and cross-functional teams to ensure documents are reviewed, updated, and approved within required timeframes. 

· Perform document control functions, including tracking, formatting, version control, distribution, and archiving. 

· Evaluate document organization, proofread materials, and perform quality checks prior to finalization.

Regulatory Monitoring and Reporting 

· Monitor and stay informed of changes in federal, state, and local regulations impacting healthcare and behavioral health services, including CMS guidance, Kansas and Missouri statutes and administrative rules, DMH directives, and Medicaid policy updates. 

· Assist in interpreting regulatory guidance and translating requirements into actionable operational practices. 

· Support timely and accurate reporting to regulatory agencies, state oversight bodies, and internal leadership, as required by CMS, DMH, and contractual obligations. 

· Assist with maintaining readiness for unannounced surveys, audits, and site visits.

Privacy, Complaints, and Investigations 

· Receive, document, investigate, and assist in resolving compliance- and privacy-related complaints or concerns.

· Maintain compliance, privacy, and investigation logs as required by law and organizational policy. 

· Support corrective actions and follow-up activities to ensure sustained compliance.

Training and Education 

· Assist with compliance, privacy, and regulatory training initiatives aligned with CMS, DMH, HIPAA, and Medicaid requirements. 

· Support onboarding, annual, and refresher training related to compliance, documentation standards, incident reporting, abuse and neglect prevention, privacy, and ethical responsibilities. 

· Promote awareness of regulatory expectations and individual accountability across all levels of the organization to support survey readiness and continuous compliance.

Change Management and Customer Service 

· Support implementation of regulatory and policy changes through clear communication, practical planning, and collaboration. 

· Help build understanding, commitment, and adoption of compliance-related changes across departments.

· Respond promptly and professionally to internal and external inquiries related to compliance.

Professional Conduct and Organizational Expectations 

· Demonstrate dependability by following instructions, meeting commitments, and taking responsibility for assigned duties. 

· Maintain professionalism under pressure and respond constructively to changing priorities. 

· Promote diversity, equity, and inclusion by respecting cultural differences, supporting EEO principles, and fostering a harassment-free environment. 

· Perform other related duties as assigned by management.

ALIGNMENT WITH BHA CORE VALUES:

Empower Through Innovation The Regulatory Compliance Specialist seeks creative, effective solutions to complex regulatory challenges, helping BHA continuously improve systems, processes, and outcomes while maintaining compliance.

Integrity in Action This role operates with the highest standards of honesty, accountability, confidentiality, and professionalism, ensuring BHA consistently does the right thing, even when unobserved.

Advocate with Passion Through diligent compliance oversight, this position helps protect the rights, dignity, safety, and voices of the individuals and families BHA serves.

Leaders in Learning The Regulatory Compliance Specialist remains informed, curious, and engaged, continuously learning about evolving regulations, best practices, and evidence-based approaches to compliance and risk management.

Compassionate Care, Always Compliance activities are carried out with empathy, respect, and understanding for staff, clients, and families, recognizing the human impact behind every regulation and policy.

Sustainable Growth, Lasting Impact By strengthening compliance systems and managing risk responsibly, this role supports BHA’s long-term stability, ethical growth, and expanded access to high-quality services.

PHYSICAL DEMANDS: Sedentary to light work performed primarily in an office environment. Occasional standing, walking, and reaching. Continuous ability to communicate effectively and use computers and office equipment.

WORKING CONDITIONS: Primarily performed indoors in an administrative environment. May require interaction with multiple departments and exposure to confidential and sensitive information.

ACCESS TO PHI/CONFIDENTIAL INFORMATION: This position has access to Protected Health Information (PHI) and other confidential organizational, client, and employee information and must comply with all privacy and security requirements.

EQUAL EMPLOYMENT OPPORTUNITY & ADA STATEMENT: Behavioral Health Allies is an equal opportunity employer. Reasonable accommodation may be made to enable qualified individuals with disabilities to perform essential job functions.

Please note: This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities. Duties and responsibilities may change at any time with or without notice.

Requirements

REQUIRED QUALIFICATIONS:

• Bachelor’s degree in Public Administration, Business, Public Administration, Risk Management, Compliance, or a related field.
• Minimum of 3–5 years of experience in healthcare compliance, risk management, quality assurance, auditing, or a related regulatory role.
• Working knowledge of applicable healthcare regulations, including but not limited to HIPAA, Medicare,  Medicaid, insurer requirements, and state regulatory frameworks.
• Strong analytical, research, and problem-solving skills.
• Exceptional attention to detail with strong organization and document management skills.
• Ability to handle sensitive and confidential information with integrity and professionalism.
• Strong written and verbal communication skills, including the ability to clearly document findings and communicate      expectations.
• Proficiency with Microsoft Office applications (Outlook, Word, Excel, PowerPoint).
• Ability to manage multiple priorities, meet deadlines, and adapt to changing regulatory requirements.
• Demonstrated ability to work independently and collaboratively across departments.

PREFERRED QUALIFICATIONS:

• Graduate degree in Public Administration, Compliance, Risk Management, Legal Studies, or a related field. (Strong Preference given to a JD or MJ) 
• Experience working in behavioral health, social services, or healthcare organizations serving high-risk or vulnerable populations.
• Familiarity with accreditation standards and audit frameworks.
• Certification or progress toward certification such as CHC (Certified in Healthcare Compliance), CHPC, or similar.
• Experience participating in or supporting external audits, surveys, or regulatory reviews.
• Experience working with governmental regulatory agencies.
• Experience analyzing statutory law and administrative regulations and translating requirements into compliant      organizational practices.