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