Compliance/Quality Improvement Specialist

Job Description

Job Description

Description:

Mental Health Association of Nassau County (MHANC) is a not-for-profit membership organization dedicated to improving mental health in our community through advocacy, education, program development and the delivery of direct services. Our organization is looking for a motivated individual with a calling to help adults with mental illness by becoming a Compliance/Quality Improvement Specialist.

Supports agency-wide compliance, quality improvement, HIPAA privacy, auditing, incident management, and regulatory oversight activities. The position works collaboratively with agency leadership and program staff to ensure adherence to applicable laws, regulations, policies, and quality standards through monitoring, auditing, investigation, training, data analysis, and continuous quality improvement initiatives.

Essential Duties and Responsibilities

 

Compliance Activities:

• Support the ongoing administration and effectiveness of the Agency's Compliance Program and promote a culture of compliance throughout the organization.
• Assist with the review and revision of the Agency's Compliance Plan, compliance policies, and related procedures on an annual basis and as regulatory requirements change.
• Participate in compliance investigations and support the documentation, tracking, and resolution of compliance concerns.
• Assist with the development, revision, and maintenance of agency-wide and program-specific policies and procedures related to compliance, quality improvement, HIPAA privacy, and regulatory requirements.
• Assist with the identification, investigation, documentation, and tracking of potential Medicaid overpayments and related corrective action activities.
• Conduct compliance and quality monitoring activities, including documentation reviews, training compliance audits, credentialing audits, and exclusion screening audits; analyze findings, prepare reports, and monitor corrective action plans through resolution.
• Attend and document Compliance Committee meetings and support committee-related activities and follow-up.
• Assist in the investigation of HIPAA privacy incidents and support required notification, mitigation, and reporting activities.
• Perform other duties as assigned.

Quality Improvement Activities :

• Assist with the coordination, tracking, and response to external audits and reviews conducted by regulatory agencies, payers, and oversight entities, including OMH, DOH, Managed Care Organizations, and Nassau County.
• Participate in the Agency's Incident Review Committee; maintain meeting documentation and prepare quarterly and annual incident trend analyses.
• Participate in incident investigations and assist with documentation, tracking, and corrective action follow-up as assigned.
• Manage user access to the Agency's Electronic Health Record and other external systems and portals, including onboarding and deactivation activities.
• Compile, analyze, and report Consumer Satisfaction Survey results; identify trends, prepare reports, and monitor program responses and corrective actions.
• Coordinate the intake, documentation, tracking, and resolution of consumer grievances.
• Process and fulfill medical record and documentation requests from authorized external entities.
• Conduct quarterly utilization reviews and analyze findings to identify opportunities for quality improvement and regulatory compliance.
• Perform other duties as assigned.

Requirements:

Education

Bachelor’s Degree in a related field of study required.

Experiences

• One (1) to two (2) years of experience in healthcare, behavioral health, human services, compliance, quality improvement, auditing, or a related field preferred. 
• Experience working in the human services, behavioral health, or healthcare field preferred. 
• Proficiency in Microsoft Office Suite. 
• Working knowledge of Electronic Health Record (EHR) systems preferred. 
• Ability to work independently, manage multiple priorities, and collaborate effectively within a team environment.

Other Qualifications

• Excellent written, verbal, and interpersonal communication skills. 
• Strong analytical, organizational, and problem-solving abilities. 
• Ability to understand and apply regulations, policies, procedures, and audit findings.
• Strong attention to detail and ability to maintain confidentiality of sensitive information. 
• Effective time management skills with the ability to prioritize competing responsibilities and meet deadlines. 
• Ability to work collaboratively with staff at all organizational levels. 
• Ability to prepare reports, analyze data, and identify trends to support compliance and quality improvement initiatives. 
• Ability to communicate professionally and effectively with consumers, staff, external agencies, and stakeholders. 
• Demonstrated commitment to the Agency's mission, values, Code of Conduct, and a diverse and inclusive workplace environment. 
• Flexibility to adapt to changing priorities, assignments, and regulatory requirements. 
• Excellent attendance, punctuality, and reliability.