Compliance Specialist

Job Description

Job Description

POSITION SUMMARY

America’s Home Health Services is seeking a highly organized, detail-oriented, and proactive Compliance Specialist to oversee and maintain the agency’s day-to-day regulatory compliance and audit-readiness program.

The Compliance Specialist is responsible for ensuring that America’s Home Health Services is audit-ready 100% of the time. This position will monitor employee, Direct Care Worker (DCW), Direct Support Professionals (DSP), client/patient, branch, licensing, training, EVV, and operational compliance requirements and ensure that all required documentation is complete, current, properly maintained, and readily available for review.

This is not a position where compliance is reviewed only when an audit occurs. The expectation is that every employee file, client file, branch file, license, credential, training record, EVV report, and required regulatory document is maintained continuously at a level that would allow the agency to respond confidently to an audit or survey at any time.

The Compliance Specialist will work closely with Human Resources, Recruiting, Operations, Clinical, Scheduling, Payroll, Billing, Branch Leadership, Client Services, and Executive Leadership to identify compliance issues before they become deficiencies.

The successful candidate must be comfortable holding departments accountable, following up on missing documentation, establishing deadlines, escalating unresolved issues, and working collaboratively with teams to correct deficiencies.

CORE RESPONSIBILITY

100% AUDIT READINESS

The primary responsibility of this position is to maintain the agency's compliance systems at 100% readiness at all times .

The Compliance Specialist will:

• Maintain a continuous state of audit readiness.
• Conduct routine and scheduled internal compliance audits.
• Identify missing, expired, incomplete, or inconsistent documentation.
• Establish corrective action deadlines.
• Follow up with responsible departments until deficiencies are corrected.
• Escalate unresolved compliance issues to management.
• Maintain documentation of corrective actions.
• Prepare the agency for Pennsylvania Department of Health, DHS, OLTL, ODP, payer, EVV, Medicaid, and other regulatory or program audits.
• Maintain organized electronic and/or physical compliance records.
• Ensure that required documentation can be located quickly when requested.
• Develop and maintain compliance checklists, tracking reports, expiration calendars, and audit tools.
• Continuously monitor regulatory changes that may affect the agency.

The standard is simple: If an auditor requested a file today, the file should be ready today.

1. EMPLOYEE COMPLIANCE

The Compliance Specialist will oversee the compliance approval process for all Direct Care Workers and other applicable employees.  Responsibilities include verifying and approving required documentation before an employee is permitted to provide services.

DCW/DSP AND SKILLED HIRING APPROVAL

Review and verify, as applicable:

• Employment application.
• Identification documentation.
• Employment eligibility documentation.
• Face-to-face interview documentation.
• Employment references.
• Criminal background checks.
• Pennsylvania State Police criminal history checks.
• Federal/FBI background checks when required.
• Department of Aging determinations when applicable.
• Pennsylvania residency documentation when applicable.
• Child Abuse Clearance/ChildLine verification when required.
• TB screening/health screening.
• Required physical or health documentation.
• DCW competency documentation.
• Required certifications.
• Training completion.
• Required orientation.
• Job-specific training.
• Program-specific training.
• Client-specific training when applicable.
• Driver's license and automobile insurance when applicable.
• Any required professional license or certification.
• Documentation of expiration dates.
• Documentation required by payer, waiver, or program.
• Any additional agency-required credentialing.

2. CLIENT / PATIENT COMPLIANCE APPROVAL

The Compliance Specialist will work with Client Services, Operations, Clinical, and Scheduling to ensure that clients/patients are appropriately approved and documented before services begin.

Responsibilities include monitoring:

• Client admission documentation.
• Required assessments.
• Medicaid/waiver documentation.
• Service plans.
• Plan of Care documentation, when applicable.
• Authorized hours/units.
• Approved service types.
• Client eligibility documentation.
• Required signatures.
• Required consents.
• Physician/clinical documentation when applicable.
• Client rights documentation.
• Emergency contact documentation.
• Emergency plans.
• Required notices.
• Service start-date requirements.
• Caregiver/client matching requirements.
• Documentation necessary for billing and audit purposes.

3. TB AND HEALTH SCREENING COMPLIANCE

Responsibilities include:

• Monitoring TB screening requirements.
• Verifying baseline TB documentation.
• Tracking expiration or renewal requirements.
• Identifying employees with missing or expired documentation.
• Preventing assignment of individuals who are not compliant with required screening requirements.
• Maintaining confidential health-related documentation appropriately.
• Outreach to field staff members to keep them in compliance.

4. PENNSYLVANIA LICENSING & REGULATORY COMPLIANCE

The Compliance Specialist will maintain a comprehensive regulatory calendar covering all licenses, registrations, certifications, renewals, applications, notices, and required submissions applicable to America’s Home Health Services.

This includes monitoring requirements associated with:

Pennsylvania Department of Health

• Home Care Agency licensing.
• Home Health Agency licensing, when applicable.
• Branch/location licensing and regulatory requirements.
• License renewals.
• Change of ownership documentation.
• Administrator/point -of-contact changes.
• Required agency updates.
• Survey preparation.
• Plans of correction.
• Regulatory correspondence.
• Department of Health requests.
• Required postings and documentation.
• Applicable facility/licensure records.

DHS / OLTL

• Maintain compliance documentation and monitoring related to applicable Office of Long-Term Living (OLTL) programs, waivers, provider requirements, and authorizations.

ODP

• Maintain compliance requirements related to the Office of Developmental Programs (ODP), including applicable provider qualifications, employee requirements, training, documentation, and program-specific compliance.
• ODP licenses and services serving Pennsylvanians with intellectual disabilities and autism, including various community-based services.

Other Pennsylvania Programs

Monitor applicable requirements involving:

• Medicaid.
• Waiver programs.
• Managed Care Organizations.
• Program-specific provider requirements.
• County/program requirements.
• Payer credentialing.
• EVV requirements.
• Other governmental or contracted programs applicable to the agency.

5. BRANCH & LOCATION COMPLIANCE

The Compliance Specialist will maintain a master licensing and branch compliance file for every America’s Home Health Services location.

For each branch/location, maintain:

• Current licenses.
• License expiration dates.
• Applications.
• Renewal documentation.
• Administrator/branch leadership information.
• Required regulatory postings.
• Required policies and procedures.
• Inspection/survey documentation.
• Corrective action plans.
• Branch-specific compliance requirements.
• Program-specific approvals.
• Correspondence with regulatory agencies.
• Documentation of required changes or notifications.

6. EVV COMPLIANCE

The Compliance Specialist will oversee the agency's Electronic Visit Verification (EVV) compliance monitoring and reporting process.

Responsibilities include:

• Monitoring EVV compliance.
• Reviewing EVV exception reports.
• Coordinating corrections with Operations and Scheduling.
• Working with Payroll and Billing when EVV issues affect payroll or claims.
• Maintaining EVV compliance reports.
• Monitoring EVV submission requirements.
• Ensuring corrective actions are documented.
• Tracking recurring EVV issues by employee, client, branch, or department.
• Training employees and management on EVV expectations.

7. PERSONNEL FILE AUDITING

The Compliance Specialist will conduct routine audits of personnel files to ensure that 100% of required employee documentation is present and current .

Audits will include:

• New-hire documentation.
• Background checks.
• Child Abuse Clearances.
• FBI documentation when applicable.
• Residency verification when applicable.
• TB screening.
• Certifications.
• Licenses.
• Training.
• Competency.
• Orientation.
• Required acknowledgements.
• Employee evaluations.
• Annual requirements.
• Expiring credentials.
• Program-specific documentation.

Any deficiency must be: