What are the responsibilities and job description for the Program Integrity Specialist position at Health Connect America?
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Before you get started on your journey with Health Connect America, take some time to learn more about us. At Health Connect America, all services are guided by a unified, trauma-informed approach. Across every program, we are committed to providing compassionate, client-centered care that fosters healing and growth. Our services are delivered by clinically trained staff, grounded in a therapeutic mindset and informed by research and evidence-based practices at every level of care. Health Connect America and its affiliate brands are leaders in providing mental and behavioral health services to children, families, and adults across the nation. We provide our services directly to those in need whether that be within a person's home, their community, or in one of our office settings. Health Connect America is honored to be a part of the communities we serve and the clients we walk alongside as they embark on a journey to self-improvement and more fulfilling lives. At Health Connect America, we are dedicated to making meaningful connections every day through creating quality, affordable opportunities for individuals and families to achieve their greatest potential in a safe, positive living environment.
Come make a difference and grow with us!
Our Brands
The Program Integrity Specialist is responsible for ensuring organizational adherence to federal, state, and local regulations, contractual obligations, and internal policies as well as monitors for overall quality of services being rendered. The specialist plays a vital role in promoting ethical operations and the delivery of high-quality services. This role supports enterprise-wide consistency in compliance and quality standards and collaborates as needed to align local practices with broader system-wide goals.
Program Integrity Oversite
Employment at Health Connect America and it's companies is contingent upon meeting the requirements of a comprehensive background investigation prior to joining our team.
Health Connect America and its companies are an Equal Opportunity Employer and consider applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics, or any other basis forbidden under federal, state, or local law. For more information on Equal Opportunity, please click here Equal Employment Opportunity Posters
Before you get started on your journey with Health Connect America, take some time to learn more about us. At Health Connect America, all services are guided by a unified, trauma-informed approach. Across every program, we are committed to providing compassionate, client-centered care that fosters healing and growth. Our services are delivered by clinically trained staff, grounded in a therapeutic mindset and informed by research and evidence-based practices at every level of care. Health Connect America and its affiliate brands are leaders in providing mental and behavioral health services to children, families, and adults across the nation. We provide our services directly to those in need whether that be within a person's home, their community, or in one of our office settings. Health Connect America is honored to be a part of the communities we serve and the clients we walk alongside as they embark on a journey to self-improvement and more fulfilling lives. At Health Connect America, we are dedicated to making meaningful connections every day through creating quality, affordable opportunities for individuals and families to achieve their greatest potential in a safe, positive living environment.
Come make a difference and grow with us!
Our Brands
The Program Integrity Specialist is responsible for ensuring organizational adherence to federal, state, and local regulations, contractual obligations, and internal policies as well as monitors for overall quality of services being rendered. The specialist plays a vital role in promoting ethical operations and the delivery of high-quality services. This role supports enterprise-wide consistency in compliance and quality standards and collaborates as needed to align local practices with broader system-wide goals.
Program Integrity Oversite
- Conduct internal audits and monitoring of program and clinical records to ensure compliance with regulatory standards (Medicaid, COA, payor sources).
- Review documentation for service accuracy, billing compliance, and adherence to scope-of-practice rules.
- Review and recommend updates to internal policies and procedures to ensure alignment with changing regulations, while maintaining alignment with corporate frameworks and standards.
- Provide subject matter expertise on compliance requirements during program design or service modifications.
- Develop and deliver staff training on program integrity, documentation standards, billing compliance, and FWA prevention.
- Collaborate as appropriate to support the delivery of training content that aligns with organizational standards and enterprise-wide initiatives.
- Maintain accurate records of all audit findings, quality outcomes, and resolutions when needed.
- Prepare detailed reports for executive leadership, funders, and regulatory agencies as required.
- Bachelor’s degree in Social Services, Public Health, Behavioral Health, Criminal Justice, or a related mental health field (Master’s degree preferred).
- 2 years of experience in the human service field.
- In-depth understanding of healthcare regulatory frameworks, including Medicaid, Medicare, HIPAA, and OIG protocols, is essential.
- High attention to detail and analytical skills.
- Excellent written and verbal communication.
- Ability to maintain confidentiality and work with sensitive information.
- We recognize the importance of self-care and work/life balance.
- We offer flexibility in scheduling and provide all employees access to our Employee Assistance Program (EAP), which includes 8 mental health counseling sessions annually.
- Full-time HCA employees enjoy paid time off, paid holidays, and a comprehensive benefits package that includes medical, dental, vision, and other voluntary insurance products.
- Additional benefits include
- Access to a Health Navigator
- Health Savings Account with company contribution
- Dependent Daycare Flexible Spending Account
- Health Reimbursement Account
- 401(k) Retirement Plan
- Benefits Hub
- Tickets at Work
Employment at Health Connect America and it's companies is contingent upon meeting the requirements of a comprehensive background investigation prior to joining our team.
Health Connect America and its companies are an Equal Opportunity Employer and consider applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics, or any other basis forbidden under federal, state, or local law. For more information on Equal Opportunity, please click here Equal Employment Opportunity Posters