Compliance Specialist

The Children's Home of Poughkeepsie has been caring for children throughout the Hudson Valley for over 175 years! We strive to empower children and families to achieve optimal health and well being. We are currently seeking a full-time Compliance Specialist to work in our Quality Assurance & Improvement department.

POSITION SUMMARY:

The Compliance Specialist supports the organization's Corporate Compliance Program by promoting adherence to applicable federal and state laws, regulations, payer requirements, and organizational policies. This position assists in the development, implementation, and ongoing maintenance of an effective compliance program with a particular focus on Medicaid compliance, billing integrity, auditing, staff education, risk assessment, and regulatory preparedness.

The Compliance Specialist works collaboratively with program leadership, finance, clinical, and operational departments to identify compliance risks, monitor corrective actions, and support a culture of ethical conduct and accountability throughout the organization.

This position operates within a nonprofit organization serving youth ages 5-21 who may be experiencing mental health challenges, family instability, risk of sex trafficking, or risk of foster care placement. Programs are subject to oversight by the New York State Office of Mental Health (OMH), Office of Children and Family Services (OCFS), and other applicable regulatory agencies.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

1. Supports the ongoing maintenance of the organization's Corporate Compliance Program.
2. Assists in ensuring organizational compliance with Medicaid, OMH, OCFS, and other applicable federal and state regulatory requirements.
3. Participates in organizational compliance and risk assessment activities to identify areas of potential vulnerability and recommends mitigation strategies.
4. Assists with the development, review, and revision of compliance-related policies and procedures, internal controls, and assessments and audit tools.
5. Serves as a key participant on the organization's compliance committee, and other quality improvement committees as appropriate.
6. Conducts billing, claims, and documentation audits to assess compliance with Medicaid and payer requirements, organizational policies, and regulatory standards.
7. Monitors audit findings, track corrective action plans, and support follow-up activities to ensure resolution of identified issues.
8. Assists with internal and external compliance reviews, audits, investigations, and regulatory inquiries.
9. Delivers compliance-related training and education materials for employees, leadership, contractors, and other stakeholders.
10. Promotes awareness of compliance expectations, reporting obligations, and ethical standards throughout the organization.
11. Supports the intake, tracking, documentation, and follow-up of compliance concerns, complaints, and reports.
12. Assists the Director of QAI and Compliance in compliance-related investigations.
13. Assists the department with reviewing and evaluating records requests, and collects and provides documentation as appropriate.
14. Maintains compliance tracking systems, records, and documentation in accordance with organizational and regulatory requirements.
15. Remains abreast of regulatory updates and changes, and attends trainings and conferences as required.
16. Prepares reports, summaries, and compliance metrics for leadership, committees, and regulatory purposes.
17. All other duties as assigned by the Director of Quality Assurance and Compliance

Schedule: Business hours, minimum of 40 hours per week.

The Children's Home offers an outstanding benefit package which includes medical, vision, dental, life insurance, 403(b), tuition reimbursement, paid time off, and a great work environment! Paid time off includes 4 weeks of vacation, 3 personal days, 12 holidays and 9 sick days annually.

MINIMUM QUALIFICATIONS

• Bachelor's degree in public or healthcare administration, human services, compliance or a related field with at least two (2) years experience OR an Associates degree/certifications/experience with a minimum of (5) years in healthcare compliance, auditing, quality assurance or regulatory work
• Experience with NYS Medicaid billing OR experience working with OMH, OCFS or OMIG environments

PREFERRED QUALIFICATIONS:

• Master's degree
• Compliance certification (e.g., CCEP, CHC, CHPC)

*The Children's Home of Poughkeepsie is an Equal Opportunity Employer.

*The Children's Home participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. Employers can only use E-Verify once you have accepted a job offer and completed the form I-9.