Healthcare Compliance Specialist

The Healthcare Compliance Specialist oversees the Compliance Program for the Home Care agency, ensuring adherence to local, state laws, and regulations outlined by the New York State Department of Health, Office of Medicaid Inspector General, and company policies. This role includes the continual implementation of the Code of Conduct and other tasks supporting the objectives of an effective compliance program. The Compliance Specialist works under general supervision.

The Compliance Specialist serves as a communication channel to receive and direct compliance issues for investigation and resolution. It also acts as a final internal resource for concerned parties after other formal channels and resources have been exhausted.

Duties and Responsibilities:Manages day-to-day functions of the Compliance Program.Audits and monitors activities following the Compliance Calendar.Conducts investigations of allegations or reports of fraud, waste, abuse, or privacy violations under the direction of compliance and administrative leadership.Provide education and training to the staff on compliance-related issues.Collaborates with leadership in developing, reviewing, and revising compliance policies, procedures, and related activities for the company.Collaborates with operations to implement corrective actions and controls related to identified compliance concerns, evaluating their effectiveness.Collaborates with Human Resources and leadership to ensure consistency in disciplinary actions related to non-compliance, especially fraud, waste, abuse, and privacy violations.Reviews data and reports for patterns or trends indicating workflow process concerns, preparing reports from a compliance perspective with recommendations for addressing concerns.Assists with responses to requests from external sources for patient records.Encourages an environment for reporting compliance concerns.Keeps updated on compliance and privacy policies and regulations.Serves as a resource to staff regarding compliance-related matters and questions.Performs other duties as assigned.

Qualifications:High School Graduate with some College in business or health care education preferred.One to two years of office work experience in a compliance or auditing healthcare/home care setting.Strong written and verbal communication skills, with the ability to maintain accurate schedules, notes, and records.Good organizational and interpersonal skills are required.