Compliance Specialist

This is a fully remote position, open to applicants in Arizona, +10 more states.

📋 Description

• Assist in the design, execution, and continual upkeep of the healthcare compliance program.

• Aid in implementing the seven essential components of an effective compliance program.

• Provide guidance to internal stakeholders on compliance-related inquiries and convert regulatory requirements into practical actions.

• Support compliance and quality oversight for the Enhanced Care Management and Palliative Care programs.

• Keep track of regulatory and contractual obligations as well as evolving guidelines.

• Conduct audits, monitoring, QAPI activities, metric tracking, trend analysis, and corrective action planning.

• Collaborate across departments to mitigate compliance risks, ensure audit readiness, and incorporate standards into workflows.

• Monitor federal and state healthcare legislation, including the Anti-Kickback Statute, Stark Law, False Claims Act, and HIPAA.

• Track enforcement actions from DOJ/OIG, advisory opinions, fraud alerts, and compliance guidance.

• Perform compliance risk assessments, documenting and addressing fraud, waste, and abuse risks.

• Assist in managing regulatory changes and monitor requirements for potential new markets.

• Help with compliance audits, monitoring activities, reviews, and internal investigations.

• Coordinate responses to compliance inquiries, audits, and regulatory requests.

• Maintain documentation for investigations, audits, and other audit-ready materials.

• Support compliance training and educational initiatives.

• Promote mechanisms for compliance reporting and standards against retaliation.

• Draft communications related to compliance, guidance documents, and policy revisions.

• Work with internal teams to streamline processes and enhance regulatory preparedness.

• Stay updated on state and federal regulatory requirements.

• Assist with ad hoc compliance and quality projects.

⛳️ Requirements

• Bachelor’s degree in Healthcare Administration, Compliance, Legal Studies, Business, or a related discipline, or equivalent healthcare compliance experience.

• Minimum of 2 years of experience in healthcare compliance, regulatory affairs, audit, or a similar position.

• Proficient knowledge of federal and state healthcare compliance laws and regulations.

• Understanding of healthcare enforcement trends and OIG/DOJ Compliance Program Guidance and enforcement priorities.

• Experience supporting QAPI initiatives, audits, or quality monitoring activities.

• Strong analytical, organizational, and documentation capabilities.

• Comprehensive understanding of healthcare compliance and regulatory frameworks.

• Ability to interpret regulations and convert them into actionable guidance.

• High ethical standards and sound judgment.

• Exceptional written and verbal communication abilities.

• Detail-oriented with excellent follow-through.

• Capability to assess operational compliance gaps and make risk-based decisions.

• Applicants must reside in Arizona, California, Colorado, Florida, Georgia, Illinois, Nevada, North Carolina, Oregon, Texas, Utah, or Washington.

• Legally authorized to work in the United States.

• Background check, which may include a drug test or health screenings, required prior to employment.

• E-Verify identity and work eligibility verification upon hire.

• Influenza vaccination required for roles that involve patient, client, or customer interaction.

• Preferred: Certification in Healthcare Compliance (CHC) or similar compliance credential.

• Preferred: Experience in supporting compliance audits, investigations, or regulatory examinations.

• Preferred: Knowledge of CMS regulations and reimbursement compliance.

• Preferred: Experience with ECM, Palliative Care, or similar care management models in Medicaid or managed care settings.

• Preferred: Understanding of federal and state telehealth and digital health regulations.

• Preferred: Experience in supporting compliance programs for rapidly growing, multi-state healthcare organizations.

• Preferred: Knowledge of digital health regulatory factors, including data privacy and remote patient monitoring.

🏝️ Benefits

• Medical, dental, and vision insurance.

• Income protection benefits.

• Flexible PTO.

• Company holidays.

• 401k.

• Additional wellness benefits.

• Mileage reimbursement for field roles according to IRS guidelines.