Quality & Compliance Specialist

Quality And Compliance SpecialistThe Quality and Compliance Specialist will support the organization's compliance day-to-day quality and compliance operations, monitor contractual and regulatory requirements, and support continuous improvement efforts across programs and departments.The Quality and Compliance Specialist is also responsible for conducting audits, investigations, corrective action planning, reporting, staff support, and compliance tracking activities while promoting a culture of accountability, quality improvement, and operational excellence. This position requires strong analytical, organizational, project management, and leadership skills, as well as the ability to manage multiple priorities in a fast-paced environment.QualificationsBachelor's degree in public policy, Social Sciences, Business Administration, Healthcare Administration, or related field; or equivalent combination of education and experienceMinimum of 2 years of experience in quality compliance, auditing, healthcare administration, Medicaid programs, or related fieldPrevious experience coordinating audits, compliance reviews, corrective action plans, or regulatory reporting activitiesKnowledge of Medicaid, State, and Federal regulations and contractual compliance requirementsStrong project management, organizational, analytical, and problem-solving skillsAbility to manage multiple priorities and deadlines with limited supervisionExcellent written and verbal communication skillsStrong attention to detail and ability to maintain confidentialityExperience using Microsoft Office applications including Word, Excel, Outlook, and PowerPointAbility to learn and become proficient in all Acumen-specific systems and programsValid driver's license within state of residence and valid automobile insurancePreferred QualificationsExperience conducting Medicaid audits and regulatory reviewsExperience with quality improvement methodologies and process improvement toolsKnowledge of HIPAA requirements and healthcare compliance standardsExperience analyzing data, identifying trends, and presenting findings to leadershipExperience developing or facilitating staff training programsPrevious experience in social services, healthcare operations, or managed care environmentsRequirementsRole and Essential FunctionsMaintain detailed understanding of all current AFA contracts, provider manuals, policies, and applicable State and Federal regulationsServe as a subject matter resource regarding contract compliance, program requirements, and quality assurance processesAct as a liaison between Program Managers, Executive Directors, Operations teams, and other departments to resolve compliance concerns, contractual issues, audit findings, and operational risksAssist with the implementation and oversight of quality compliance programs, systems, and initiatives across the organizationCoordinate and oversee internal and external audits, Requests for Information (RFI), subpoenas, surveys, and regulatory reviewsFacilitate cross-department collaboration to compile accurate and timely audit documentation while maintaining compliance with HIPAA and contractual requirementsReview audit findings, identify trends and risks, and provide recommendations to leadership to support quality improvement initiativesMonitor and oversee complaint tracking, investigations, trending analysis, and escalation processesSupport departments in developing and implementing corrective and preventative action plans to resolve compliance and quality concernsResearch, analyze, and communicate changes in legislation, regulations, contracts, and program requirements that may impact operations or organizational complianceAssist in the development, implementation, and maintenance of policies, procedures, forms, reporting tools, and internal controls to support compliance objectives