Compliance Specialist

Compliance Specialist

Position Summary

The Compliance Specialist - is responsible for conducting internal investigations related

to clinical care, regulatory compliance, patient safety, documentation practices, and

ethical concerns within the home health care organization. This position works

collaboratively with leadership, clinical staff, human resources, and legal/compliance

teams to ensure adherence to federal, state, accreditation, and company standards.

The ideal candidate is an individual with strong clinical judgment, investigative skills,

knowledge of home health regulations, and the ability to objectively evaluate allegations,

incidents, and compliance concerns while maintaining confidentiality and professionalism.

Essential Duties and Responsibilities

Investigations:

Conduct investigations involving patient care concerns, clinical incidents,

documentation discrepancies, medication issues, employee misconduct, neglect

allegations, and regulatory violations.

Review medical records, visit documentation, care plans, physician orders, and related

clinical records to assess compliance and quality of care.

Interview employees, patients, caregivers, and other involved parties to gather facts and

determine findings.

Analyze clinical and operational data to identify patterns, trends, or systemic

compliance risks.

Prepare detailed investigative reports summarizing findings, conclusions, corrective

actions, and recommendations.

Regulatory Compliance

Monitor compliance with applicable federal, state, and local regulations related to home

health services, including Medicare, Medicaid, HIPAA, and agency licensing

requirements.

Assist with preparation for audits, surveys, and accreditation reviews.

Collaborate with leadership to implement corrective action plans and monitor follow-up

activities.

Maintain current knowledge of home health regulatory standards and compliance

requirements.

Quality and Risk Management

Identify areas of clinical risk and recommend process improvements to reduce liability and

improve patient outcomes.

Participate in root cause analyses and performance improvement initiatives.

Track and trend investigation outcomes to identify recurring issues and opportunities for

education or policy enhancement.

Assist in developing and revising policies, procedures, and compliance protocols.

Education and Collaboration

Provide guidance and education to staff regarding compliance expectations, documentation

standards, and ethical practices.

Serve as a resource to leadership regarding clinical compliance concerns and regulatory

interpretation.

Collaborate with Human Resources, Clinical Operations, Legal Counsel, and Executive

Leadership as needed during investigations.

Qualifications

Minimum of 3–5 years of clinical experience, preferably in home health, hospice, case

management, quality assurance, or compliance.

Previous experience conducting investigations, audits, or regulatory reviews preferred.

Strong knowledge of home health regulations, Medicare Conditions of Participation,

HIPAA, and clinical documentation standards.

Excellent analytical, interviewing, communication, and report-writing skills.

Ability to maintain confidentiality and exercise sound professional judgment.

Proficient in electronic medical record systems and Microsoft Office applications.

Physical Requirements

Ability to travel locally as needed for investigations, audits, or field visits.

Ability to sit, stand, and use standard office equipment for extended periods.

Work Environment

This position operates in a professional office and home health environment and may

involve interaction with patients, caregivers, and staff in the field. The Compliance Officer

must maintain objectivity, professionalism, and discretion in all investigative matters.

Reporting Structure

Reports to: Compliance Director