Quality & Compliance Specialist

Job Description

Job Description

Description:

POSITION SUMMARY The 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.

  QUALIFICATIONS

• Bachelor’s degree in public policy, Social Sciences, Business Administration, Healthcare Administration, or related field; or equivalent combination of education and experience 
• Minimum of 2 years of experience in quality compliance, auditing, healthcare administration, Medicaid programs, or related field 
• Previous experience coordinating audits, compliance reviews, corrective action plans, or regulatory reporting activities 
• Knowledge of Medicaid, State, and Federal regulations and contractual compliance requirements 
• Strong project management, organizational, analytical, and problem-solving skills 
• Ability to manage multiple priorities and deadlines with limited supervision 
• Excellent written and verbal communication skills 
• Strong attention to detail and ability to maintain confidentiality 
• Experience using Microsoft Office applications including Word, Excel, Outlook, and PowerPoint 
• Ability to learn and become proficient in all Acumen-specific systems and programs 
• Valid driver’s license within state of residence and valid automobile insurance

PREFERRED QUALIFICATIONS

• Experience conducting Medicaid audits and regulatory reviews 
• Experience with quality improvement methodologies and process improvement tools 
• Knowledge of HIPAA requirements and healthcare compliance standards 
• Experience analyzing data, identifying trends, and presenting findings to leadership 
• Experience developing or facilitating staff training programs 
• Previous experience in social services, healthcare operations, or managed care environments

ROLE AND ESSENTIAL FUNCTIONS

• Maintain detailed understanding of all current AFA contracts, provider manuals, policies, and applicable State and Federal regulations 
• Serve as a subject matter resource regarding contract compliance, program requirements, and quality assurance processes 
• Act as a liaison between Program Managers, Executive Directors, Operations teams, and other departments to resolve compliance concerns, contractual issues, audit findings, and operational risks 
• Assist with the implementation and oversight of quality compliance programs, systems, and initiatives across the organization 
• Coordinate and oversee internal and external audits, Requests for Information (RFI), subpoenas, surveys, and regulatory reviews 
• Facilitate cross-department collaboration to compile accurate and timely audit documentation while maintaining compliance with HIPAA and contractual requirements 
• Review audit findings, identify trends and risks, and provide recommendations to leadership to support quality improvement initiatives 
• Monitor and oversee complaint tracking, investigations, trending analysis, and escalation processes 
• Support departments in developing and implementing corrective and preventative action plans to resolve compliance and quality concerns 
• Research, analyze, and communicate changes in legislation, regulations, contracts, and program requirements that may impact operations or organizational compliance 
• Assist in the development, implementation, and maintenance of policies, procedures, forms, reporting tools, and internal controls to support compliance objectives