STATUS – OPEN
Title: Compliance Officer
Reports To: Executive Director
Supervisory Responsibility: Not Applicable
Essential Functions of the Role:
- This position records, aggregates, analyzes, and reports audit results, identifying error trends and root causes, and making recommendations for performance improvements.
- Conducts standard random and focused audits to determine compliance to all funding sources list here but not limited to: Medicaid, OMH, Westchester County Department of Mental Health, DOH.
- Initiates, facilitates, and promotes activities to foster compliance awareness and to encourage reporting of compliance issues within the organization and related entities.
- Manage workflow for Health Home HARP clients to enroll in Home and Community Based Services (HCBS). Monitor compliance with all policy, procedures, and documentation requirements for HCBS. Supervise HCBS staff and ensure all requirements are met for billing submission.
Educate employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process and Medicaid, PHI as well as to conduct trainings in other areas as needed.
- Conduct periodic audits for performance management and proper coding.
- Identify and recommend process improvement initiatives based on audit trends.
- Maintain accurate database of audit results.
- Participate in the review of departmental productivity and performance reports and takes an active part in the development of action plans for agency performance improvement.
- Remain updated on all member and provider policy changes made by the Health Home, Medicaid, HCBS and other governing agencies. Update existing or draft new policies to reflect current regulations.
- Work with all departments to ensure member satisfaction and timely resolution of grievances and appeals reports.
- Manage database and spearhead review process for agency incidents, complaints/grievances.
- Perform other duties as assigned
Qualifications for this Role:
- QUALIFICATIONS: MSW, MBA, MPH or related MA/MS degree, or Bachelor’s Degree with 5 years’ experience including a minimum of 2 years’ experience in quality assurance and compliance in the non-profit sector.
- Strong administrative, managerial and leadership skills.
- Strong verbal and written communication skills
- Excellent computer skills (MS Word & Excel) required
- Understanding of social service programs, including program planning, operations, and evaluation
- Ability to prioritize and handle multiple tasks
- Ability to synthesize information and transfer it to practice
- Excellent organizational skills
- Creative problem solver
- Ability to exercise initiative and “follow through”
- Demonstrated experience developing and implementing training programs.
- Knowledge of NY State Medicaid Redesign and DOH Health Home Regulations preferred
- Experience writing policy and procedure for non-profits
- Flexible, works well independently, with strong attention to detail
To submit an application, please email firstname.lastname@example.org.