Compliance Specialist

Job Description

Job Description

The Compliance Specialist will work with the Patient Care Coordinator and other administrative staff to oversee and monitor all aspects of coordinating patient care, including maintaining all documentation while the patient is enrolled in the Center. This position will acquire approval for treatment and act as the Privacy Officer. This position may also assist in oversight of the classrooms, as needed. The Compliance Specialist must meet the requirements to be an Early Childhood Developmental Specialist (ECDS) and may assist in ensuring all required classroom documentation is timely and accurate, including the Individualized Treatment Plan. This position may also ensure appropriate habilitation services in areas of cognition, communication, social/emotional, motor and adaptive skills; or to reinforce skills learned and practiced in occupational, physical and/or speech therapy.

The Compliance Specialist acts as the local Compliance Officer and HIPAA Security and Privacy Officer for their designated Center.

Summary of essential job function

• Follow Arkids Pediatric Day Centers’ Employee Handbook, Management Policies and Procedures Manual, and Medical Policies & Procedures Manual
• Ensure all policies and procedures are implemented by staff members, maintaining compliance at all times with all regulations determined by regulatory agencies
• Maintain standards set forth by Arkansas Minimum Licensing, Division of Provider Services and Quality Assurance (DPSQA), Medicaid, Arkansas Department of Health, EQHealth (or other gatekeeper to Medicaid), and all other regulatory agencies
• Maintain open communication with parents, families, visitors, all Arkids Pediatric Day Centers’ personnel, and outside contacts
• Attend and actively participate in job-related functions
• Represent the program to parents/guardians, visitors, and the public in a positive way
• Make home visits (with other staff) as needed for various problems such as patient absences, assessment for environmental risk, to obtain required documentation, signatures, etc.
• May assist with marketing visits
• May fill in for other positions (ex. cover the front desk for the Administrative Assistant, cover breaks for Classroom Staff)
• May assist with loading/unloading the van
• May perform light housekeeping duties
• Other duties as assigned
• Submit any required authorizations or extension of benefits (EOB) to the gatekeeper(s) to Medicaid)
• Manage all Medicaid denials and appeals
• Receive all therapy evaluations and monitor all re-evaluations, ensuring copies of evaluations are forwarded to parents/guardians and PCPs when completed
• Maintain a list of upcoming re-evaluations as a double-check system and submit it to the therapists the month before it is due
• Maintain a tracking system on each patient that monitors/tracks all EIDT, authorizations, DMS-642s, and any other enrollment items
• Submit for new DMS-642s 1 month prior to the expiration date on all patients or the same day of a new evaluation if the prescribed minutes change
• Manage the storage system for patient medical records and other documentation
• Assist with managing the thinning of all active patient charts, as needed
• Create a hard chart on each patient within 1 week of enrollment
• Complete chart reviews on all patients after 2 weeks of enrollment and every 90 days thereafter, including 10% in discharge patients
• Issue deficiency sheets, as needed, and ensures all corrections are completed by the responsible individual within 72 hours, as indicated by their signature
• Initiate and manage the discharge process for all patients discharged from the Center, ensuring all required notifications are sent out appropriately
• Openly communicate with the Center Director and/or Program Administrator before beginning the process of discharging any patient
• If a patient still qualifies for any therapy, the Compliance Specialist will ensure a therapist from that discipline(s) has spoken with the parent/guardian in an effort to transition the patient from the EIDT program to the Outpatient program
• Actively participate in weekly Administrative Meetings
• Update their sections of the Administrative Meeting Agenda and submits it to the Center Director the day before the scheduled meeting (unless otherwise specified)
• Assist with the intake process and coordinating of admissions, as needed
• Assist with monitoring the daily attendance and follow up on absences, as needed
• Search by the patients’ names before you create a new profile, they may already be in the system
• Ensure all profile information is accurate and up to date on all new patients
• Update Patient Frequency for therapy immediately when the new prescription to treat is received
• Close out customers when switch from contingency to EIDT
• Monitor and update the Unbillable Tab a minimum of weekly
• Review the New Customer Report a minimum of weekly to ensure the contingency customers and the Arkids/EIDT customers are changed over and correct
• Ensure DNQ is marked/unmarked as appropriate, along with the billing dates
• Review the Patient Profile to ensure it is accurate and current
• Ensure completion of each discipline tab for service billing dates and repeat this step for any added customer
• Check inbox daily (for example: looking for evaluation notification to update DMS-642)
• May assist with billing for the classrooms
• Ensure a positive emotional climate for the patients by showing respect to children and adults through a willingness to help others
• May assist with developing an Individualized Treatment Plan (ITP) for each EIDT patient with 1 week of enrollment and a minimum of annually thereafter.
• May assist with day-to-day staffing needs and ensure that appropriate adult-to-child ratios are maintained.
• May assist with programmatic management/supervision of the educational classrooms and classroom staff as it relates to implementation of each child’s ITP
• May provide guidance and supervision of classroom planning and activities
• May assume the role as direct service provider when necessary and ensure continual supervision of children assigned to his/her care while promoting a safe, healthy environment and positive emotional climate for the classroom
• May assist with updating treatment plans, goals, and objectives and distribute to classroom staff
• May assist with scheduling and coordinating ITP meetings at a minimum of annually
• May assist with ensuring the approved developmental assessment is administered timely and appropriately to all potential patient and enrolled patients
• May assist with completing and check daily classroom billing by the designated due dates (currently Wednesdays at 11:00am for F/M/T and Fridays at 11:00am for W/Th)

Minimum requirements

• BSE in Early Childhood Education or related field with emphasis on Early Childhood plus a minimum of 6 months of experience working with young children in a group-care setting & documentation of 12 hours of coursework in early Childhood, Child Development, Special Education, Elementary Education, Child and Family Studies, or has completed state accreditation in Early Childhood Special Education
• 5 years of experience in Early Childhood Education or related field preferred
• Clear Criminal Record Check, Arkansas Child & Adult Maltreatment Regulatory Checks, FBI Regulatory Check, including National Sex Offender Registry
• May be asked to complete New Director Orientation
• Pass a drug screen (upon hire, annually, and/or randomly)
• Travel as needed
• Valid Arkansas Driver’s License, including a P endorsement if needed
• Clear Driving Record

Abilities Required

• Ability to communicate effectively with co-workers and supervisors
• Ability to work with children
• Ability to handle multiple tasks in a very busy environment
• Ability to carry out instructions
• Ability to clean efficiently and timely
• Ability to lift up to 50 lbs
• Ability to bend, stoop, stand, walk, pull, and reach for several hours per day
• Ability to demonstrate basic computer skills

*Paid Time Off, Medical, Vision, Dental, Supplemental Insurances, Life Insurance, 401k*