Clinical Compliance Specialist

Job Description

Job Description

Description:

The Clinical Compliance Specialist serves as the internal expert in behavioral health regulatory standards and the lead for CHRIS180’s compliance-based Continuous Quality Improvement (CQI) initiatives. Primary focus areas include ensuring compliance with DBHDD requirements, Medicaid regulations, accreditation standards, private insurance guidelines, and funder clinical expectations.

The Clinical Compliance Specialist focuses on improving clinical quality, reducing audit risk, strengthening documentation practices, and driving sustainable operational improvements through data analysis and cross-functional collaboration.

Role and Responsibilities

The primary duties include but are not limited to the following:

Regulatory Leadership & Expertise

· Ensure compliance with all applicable federal, state, and local regulations, accreditation standards, licensing requirements, and organizational policies.

· Oversee operational readiness for audits, accreditation reviews, licensing inspections, and regulatory surveys.

· Monitor compliance metrics and implement corrective action plans as needed.

· Maintain current knowledge of regulatory changes impacting behavioral healthcare operations with a focus on DBHDD, Medicaid, and commercial insurance.

· Actively monitor regulatory updates and communicate changes throughout CHRIS180.and determine operational impact. 

· Serve as the primary internal resource for interpretation of behavioral health regulations. 

· Coordinate implementation of new regulatory requirements across departments. Maintain payer requirement reference materials.

· Ensure policies remain current based on DBHDD updates, Medicaid policy changes, audit findings and results, and commercial insurance guidelines. 

· Update policies to ensure alignment and promote operational efficiency and clinical best practices.

· Partner with Revenue Cyle, Billing, Clinical Services, Operations, and Utilization Management to ensure compliance. 

· Develop educational resources and deliver trainings as regulations evolve. 

· Coordinate with Utilization Management to support their insurance paneling & credentialing efforts.

Performance Monitoring & Continuous Quality Improvement

· Produce compliance dashboards for executive leadership on a monthly and quarterly basis with actionable recommendations.

· Facilitate compliance-based Quality Improvement meetings.

· Develop and monitor quality metrics for documentation compliance, authorization timeliness, treatment plan compliance, assessment completion rates, service delivery timeliness, audit findings, corrective action completion, and clinical documentation trends. 

· Analyze trends involving audit outcomes, documentation deficiencies, authorization denials, claim trends, compliance indicators, and clinical quality measures.

Investigations & Risk Management

· Conduct internal investigations involving reported fraud, waste, or abuse allegations.

· Conduct regular chart audits to identify and correct compliance risks. 

· Monitor adherence to industry standards, including insurance payer requirements, Medicaid documentation guidelines, and legal mandates. 

· Coordinate with Compliance Manager, Clinical leadership and Executive Leadership regarding compliance concerns.  

TOTAL REWARDS at CHRIS 180

• Hybrid work schedule based on department/program needs
• Paid Time Off (PTO)
• 11 paid holidays, including company break from 12/24 - 1/1
• Competitive 403 (b) benefit defined contribution plan
• Healthcare insurance options (HMO and PPO)
• Dental and Vision insurance options
• Employer-paid short-term disability 
• Employer-paid basic life insurance (1x times your salary)
• Employee Assistance Program (EAP)
• Flexible Spending Account (FSA)
• Discounted college tuition for select colleges and universities

· Bachelor’s degree required in Healthcare Administration, Business Management, Psychology, Social Work, Counseling, or a related field. Master’s Degree preferred.

· Clinical experience preferred.

· Accreditation experience preferred.

· Minimum of 3-5 years’ experience in behavioral healthcare, healthcare, or related regulated entity with a strong background in Medicaid, Insurance, Billing, clinical documentation compliance.

· Experience with data analysis, reporting, performance measurement, and performance improvement. 

· Experience conducting and responding to audits, reviews, and/ or investigations.

· Excellent written, verbal, and presentation skills.

· Proficiency with Electronic Health Record systems and Microsoft Office applications.

· Demonstrated ability to partner effectively with others in handling complex issues.

· Strong influencing skills and sound business judgment. 

Schedule

This position works an average of 80 hours bi-weekly. The work schedule requires flexibility to meet the needs of the program and availability on an emergency or project basis. Work tasks may vary and will be outlined daily, weekly, or quarterly by the Compliance Manager and Chief Program Operating Officer. Primary hours are Monday – Friday between 8:00 am-5:00 pm. 

Work Site

The primary work site is CHRIS 180 headquarters at 1030 Fayetteville Rd, SE, Atlanta, GA 30316. Work locations may be at any of the CHRIS 180 facilities or centers. 

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee is frequently required to sit, stand and reach with hands and arms. The employee is occasionally required to lift and/or move up to 20 pounds.