Compliance Specialist - Homecare & Hospice (Full time, day shift)

Compliance Specialist

Position Summary: Provides and supports regulatory, accreditation and certification activities to achieve and sustain ongoing compliance. Takes action to assure timely and complete preparation, support and follow-up to surveys, reviews and investigations. Represents the organization in interfaces with regulatory and accreditation agencies. Remains current with state and federal regulations and communicates that information within the organization. Works closely with leaders to develop and implement plans to meet new or revised regulations or standards.

Key Responsibilities:

• Regulatory Compliance: Monitor and interpret federal, state, and local healthcare regulations, including HIPAA, Medicare, Medicaid, and accreditation standards (e.g., NYS DOH). Acts as a liaison with health system regulatory partners (e.g. Corporate Compliance, Privacy Program, etc). Prepare and submit regulatory agency applications, reports, or correspondence ensuring compliance with applicable laws and regulations. Lead the agency review and response to fast-tracked discharge appeals, insurance audits, and CMS Contractor audits.
• Quality Assurance: Conduct regular audits, assessments, and performance evaluations to identify areas for improvement and monitor compliance with CMS Conditions of Participation.
• Healthcare Accreditation: Coordinate and facilitate accreditation activities, such as accreditation surveys, readiness assessments, and corrective action plans. Prepare documentation and evidence for accreditation surveys and ensure compliance with accreditation standards.
• Policy and Procedure Development: Develop and maintain the organization's policy and procedure library. Ensure that policies are up-to-date, comprehensive, and aligned with regulatory requirements and best practices.
• Risk Management: Identify and assess risks to patient safety, data security, and organizational integrity. Develop risk mitigation strategies and corrective action plans to address identified risks and prevent adverse events or compliance violations.
• Training and Education: Provide training and education to staff on regulatory requirements and compliance standards. Collaborate with departmental leaders to develop and deliver training programs that promote a culture of quality and compliance.
• Data Analysis and Reporting: Collect, analyze, and interpret data related to compliance measures. Prepare reports, dashboards, and presentations to communicate findings and trends to leadership and stakeholders.
• Investigations and Root Cause Analysis: Investigate incidents, complaints, and adverse events to determine root causes and contributing factors. Implement corrective actions and preventive measures to address identified issues and prevent recurrence.
• Performs other regulatory compliance duties, as assigned.

Desired Attributes:

• Master's degree preferred
• Regulatory audit/survey experience in a healthcare setting
• Experience with metrics and reporting
• RN or another clinical license/certification strongly preferred
• Knowledge/understanding of laws and regulations governed by NYS and CMS

Minimum Qualifications:

• Bachelor's degree
• Minimum of 1 year experience in one or more of the following: Home Health Care OR Clinical Compliance OR Health Care Administration

Required Licensure/Certification: NA

Physical Requirements:

S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.

Pay Range: $70,000.00 - $95,000.00

City: Rochester

Postal Code: 14607

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.