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Compliance Specialist

STATUS – NO CURRENT OPENINGS

Title: Compliance Specialist

Reports To: Executive Director

FLSA: Non-Exempt

Status: Full-time

Supervisory Responsibility: Not Applicable


Essential Functions of the Role:

  • Work closely with Senior Management to ensure all current and emerging business activities meet compliance requirements.
  • Coordinate and ensure timely completion of all required government, compliance, and regulatory documents for all departments.
  • Conducts standard random and focused audits to determine compliance to all funding sources listed here but not limited to: Medicaid, OMH, Westchester County Department of Mental Health, DOH.
  • 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.
  • Draft responses to queries by external regulatory agencies and act as an internal resource for questions regarding compliance issues.
  • Initiates, facilitates, and promotes activities to foster compliance awareness and to encourage reporting of compliance issues within the organization and related entities.
  • Assist with the educating of 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.
  • Participate in the review of departmental productivity and performance reports and be proactive 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, 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.
  • Under the guidance of the Compliance Officer, maintain database and assist with the review process for agency incidents, complaints/grievances.
  • Perform other duties as assigned.

Qualifications for this Role:

  • Bachelor’s degree, Master’s preferred
  • Knowledge of NY State Medicaid Redesign and DOH Health Home Regulations
  • Ability to interpret, correlate, and ensure the agency maintains compliance with accreditation standards
  • Experience writing policies and procedures for non-profits
  • Flexible, works well independently, with great attention to detail

To submit an application, please email careers@choiceofny.org.