Compliance Specialist

Description

Community Options, Inc. is a national non-profit agency providing services to individuals with disabilities in 12 states.   

We are now hiring a Full-Time Compliance Specialist in East Stroudsburg, PA. The Compliance Specialist is responsible for monitoring billing records to ensure compliance with Federal and State regulations for the Centers for Medicare & Medicaid Services and HHS requirements through billing, identifying potential errors, and recommending corrective actions by reviewing individual records, billing codes, and documentation. This person will be held accountable for ensuring the appropriate implementation of policies and procedures, and ensuring programs are completely in compliance with federal and state rules, regulations, and agency policies. This role requires leveraging data insights to enhance compliance processes and reporting.

• Conduct audits of financial and personnel files to include training records, electronic health records, and billing documentation
• Conduct comprehensive record reviews
• Utilize data analytics to monitor, assess, and identify compliance risks, trends, and areas for improvement.
• Performs claims review
• Examine billing codes for accuracy, including proper modifiers
• Investigate reports of potential non-compliance and provide comprehensive reports on findings with recommendations
• Submit reports, dashboards, and presentations using Microsoft Office and business intelligence tools to the Compliance Manager
• Communicate findings of audits to the Compliance Manager and Director of Data Analytics
• Maintain a master file of all audits
• Keep up-to-date with applicable laws, regulatory requirements, and best practices
• Additional tasks and responsibilities may be assigned

• Bachelor’s degree in healthcare administration, accounting, or a related field and three years of relevant experience
• Valid driver’s license with a satisfactory driving record
• Experience with billing practices and guidelines
• Understanding of Medicaid regulations
• Ability to present facts and recommendations effectively in oral and written form
• Independent judgment is required to plan, prioritize, and organize diversified workload
• Strong proficiency in Microsoft Office, particularly Excel
• Knowledge and understanding of local regulatory agency operations
• Employment is contingent upon successful completion of checks of criminal background, central registry, child abuse registry, and drug testing 

• Competitive Insurance Benefits (Medical, Dental, Vision) 
• Paid Holidays—Including a Birthday Holiday 
• Generous PTO 
• Employee Incentive & Discount Programs 
• 403b Retirement Plan 
• Incredible career growth opportunities 
• University partnerships that include tuition reduction