Compliance Specialist

Job Purpose: The Compliance Specialist assists and supports the development, implementation, and monitoring of the Corporate Compliance Program. Under the direction of the Director, Rev Cycle Optimization, the Compliance Specialist; is responsible for collaborating with managers to provide on- going risk assessments, compliance audits, review and development of comprehensive and integrated policies, procedures and contracts, compliance training, protocols, and internal investigations. This role actively participates in the Corporate Compliance Program through participation in designing and implementing an effective program to monitor and promote compliance with federal, state, local and contractual regulations.

Essential Job Functions:

(Reasonable Accommodations may be made to enable individuals with disabilities to perform these essential functions.)

• Serves as Agency Contract Specialist, by coordinating the contract review and renewal process from start to finish
• Assists in the review, development, and implementation of annual Compliance Work Plan.
• Consults, advises, and assists program managers and business units regarding ethics, site surveys and compliance issues.
• Assists, monitors and enforces changes to rules and regulations to ensure contractual compliance with legal requirements applicable to the organization’s provision of acute, primary, and long-term care services.
• Monitors the organization’s licensing obligations as required by its healthcare contracts and support programs in seeking and/or maintaining appropriate licenses.
• In coordination with the Compliance Manager, initiates, develops, and implements policies and procedures across the organization to promote compliance with applicable regulations and contractual obligations.
• Identifies potential areas of contract and regulatory compliance vulnerability and risk; develops, implements, and monitors internal corrective action plans for resolution of issues.
• Performs special assignments and or projects as assigned.

Required Education, Experience, Certifications, Licensure and Credentials: (Where appropriate, education and/or experience may be substituted)

Minimum Required Education: A bachelor's degree is required; master's degree, Certification in Healthcare Compliance, or certified auditor credential desired.

Minimum Required Experience: A minimum of 3 years’ experience in a legal, healthcare, or social services organization or unit of government pertaining to compliance, auditing and/or investigations. Leadership, project management and collaboration experience desired.

Required License – Certification – Registration: Issued By Governing Body (if applicable): n/a

Travel outside of office: 10% travel in the communities we serve
Knowledge – Skills – Abilities:

• Familiarity with HIPAA, Medicaid and Medicare regulations, and employment law
• Strong computer skills, including multitasking between applications
• Strong interpersonal skills and ability to quickly establish rapport with people
• Strong organizational and time management skills
• Excellent verbal and written communication skills.
• Ability to read and understand various written materials, some of which are complex.
• Ability to effectively communicate and understand orally and in writing.

Physical Requirements, Visual Acuity, and Work Conditions:

Physical Requirements: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

Visual Acuity: The worker must have close visual acuity to perform activities such as preparing and analyzing data and figures; transcribing; viewing a computer terminal.

Working Conditions: None: The worker is not exposed to adverse environmental conditions.