Compliance Specialist (Clinical)

Job Description

Job Description

Description:

Work Where You Matter!

At Lifecare Home Health Family we guide patients and families through the end-of-life journey. Through compassionate care, we focus on our patient’s quality of life, empowering them to make the most of their time with dignity, comfort and respect. If you are ready to be part of an extraordinary team of caregivers, then come work where you matter.

We are seeking a Compliance Specialist to join our growing team!

Position Overview

The Compliance Specialist is responsible for assisting with the development and implementation of the compliance audit program to ensure regulatory adherence, risk mitigation and operational integrity. This role ensures that Lifecare Home Health Family complies with federal and state laws and regulations and internal policies by identifying potential risks and working cross-functionally to implement corrective actions. The Compliance Specialist will lead risk assessments, internal audits and compliance investigations while collaborating with leadership to mitigate risks and strengthen internal controls.

 

Essential Functions and Skills

Responsibilities

• Governmental Additional Documentation Requests (ADRs)
• Responses timely and accurately to governmental audits for hospice and homecare
• Prepares and tracks appeals processes
• Compliance Audit Program Development and Execution
• Assist with the development and implementation of a comprehensive compliance audit program tailored to meet the requirements of CMS, Medicaid, Medicare, Medicare Advantage plans, other government payors, private insurers, the Office of Inspector General (OIG) and the Department of Justice (DOJ).
• Develop audit frameworks, methodologies and policies that align with regulatory requirements and best practices within healthcare.
• Ensure audits are thoroughly documented and findings are reported with corrective action recommendations.

Requirements:

Preferred

The ideal candidate should have 2–5 years of healthcare compliance, clinical auditing, utilization review, or medical record review experience, preferably with direct experience in hospice and/or home health and a strong understanding of Medicare requirements, Conditions of Participation, eligibility, billing requirements, and documentation standards. This position will be responsible for reviewing and preparing PPEO, TPE, and other ADR records, identifying clinical and technical vulnerabilities, coordinating record requests and supporting documentation, and ensuring complete, accurate, and timely submission of responses. Experience with Medicare ADRs, TPEs, pre-claim or post-payment audits, hospice eligibility, F2F/CTI requirements, interdisciplinary documentation, and claim review is highly preferred. 

 

Physical Requirements

The physical requirements described are representative of those that must be met to successfully perform the essential responsibilities of this position. Reasonable accommodation may be made.

• Prolonged periods sitting at a desk and working on a computer.
• Pushing/Pulling and Lifting/carrying up to 10 pounds.