Compliance Specialist III

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Conduct reviews for clinical compliance

• Assess prepayment claims to ensure they meet regulatory and coverage standards

• Execute clinical evaluations of both pre- and post-payment claims to confirm compliance

• Analyze clinical documentation against coverage policies and service definitions

• Utilize independent clinical judgment to assess compliance and pinpoint discrepancies

• Oversee assigned compliance cases from initiation to resolution

• Investigate claims of non-compliance

• Assess case findings and determine suitable corrective measures

• Ensure complete case files are maintained in line with regulatory and accreditation requirements

• Track review timelines to guarantee completion within specified timeframes

⛳️ Requirements

• A Master's degree

• At least one (1) year of experience in behavioral health, mental health, substance use, developmental disabilities, or co-occurring disorders

• Active North Carolina licensure as a Licensed Clinical Social Worker (LCSW), Licensed Clinical Mental Health Counselor (LCMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Psychological Associate (LPA), Licensed Clinical Addictions Specialist (LCAS), or Registered Nurse (RN)

• Must possess a valid driver's license

• Must reside in North Carolina

• Willingness to travel within the catchment area as necessary

• All applicants must successfully complete a drug test as a condition of employment

🏝️ Benefits

• A collaborative, mission-focused workplace

• Competitive benefits package and remote work options for most roles

• Opportunities for professional development within a diverse and inclusive environment

• Flexible work schedules available for certain positions with management approval

• Work-from-home options accessible for most roles

• Health Insurance with no premium required for employee coverage

• Flexible Spending Accounts

• 24 days of Paid Time Off (PTO) plus 12 paid holidays during your first year

• NC Local Government Retirement Pension (defined-benefit plan)

• 401k plan with a 5% employer match and immediate vesting

• Qualifying employer for Public Service Loan Forgiveness (PSLF)

• Quarterly stipend for remote work supplies