Compliance Specialist (27005)

Thrive Behavioral Health is actively seeking a Compliance Specialist to join the Rosedale Office team as a result of continued growth and expansion. The Healthcare Compliance Specialist is responsible for ensuring the Company remains in compliance with all local, state, and federal regulations and requirements and along with Joint Commission accreditation and COMAR standards. Investigates, audits, and reports on clinical charts, as appropriate.

AGE/PATIENT POPULATIONS (S) SERVED

Age of Patient Population Served: The Healthcare Compliance Specialist will not provide direct patient care, but will be participating in quality improvement efforts related to the care of: Children (3 -18 years old) Adult (19 years old and up)

Compliance Manager 1Populations Served: The Healthcare Compliance Specialist will not provide direct patient care, but will be participating in quality improvement efforts related to the care of: Persons meeting the DSM 5 criteria for mental health disorders and individuals with co-occurring psychiatric illness.

EXPECTATIONS OF ALL STAFF

1. Adheres to all Thrive Behavioral Health Policies and Procedures.

2. At all times, conducts self in a manner that represents Thrive Behavioral Health values.

3. Maintains a positive and respectful attitude with all work-related contacts.

4. Communicates regularly with supervisor about departmental and Thrive Behavioral Health concerns.

5. Consistently reports to work and meetings on time, prepared to perform the duties of the position.

6. Meets productivity standards and performs duties as workload necessitates, including one (1) evenings until approximately 7:30-8:00 pm, unless otherwise approved.

7. Consistently demonstrates an accurate understanding and application of his/her specific role in the surveillance,

prevention, and control of infections to children, families, visitors, and staff according to Thrive Behavioral Health policies and procedures.

8. Promotes a safe environment through:

• Performing duties in a manner that upholds OSHA standards

• Following infection control policies and procedures

• Adhering to facility and department safety policies

• Reporting all potential safety risks

• Completing incident reports in a timely manner as defined in Thrive Behavioral Health’s policies and procedures

• Supporting company health and infection control policies

• Responding correctly to codes and drills

• Utilizing supplies in a cost effective manner

ESSENTIAL DUTIES AND RESPONSIBILITIES

Under the direction of Compliance Manager:

1. Conducts and coordinates internal compliance audits and analyses through client chart reviews, quality assurance, phone calls, client meetings, etc.
2. Keeps abreast of current literature and developments in the field and attend or completes required agency trainings.
3. Contributes to the successful achievement of the organization’s mission and strategic initiatives by supporting the Compliance Manager in planning, organizing and directing the various functions.
4. Builds relationships and interacts with all Staff, as needed.
5. Objectively reviews and evaluates compliance issues/concerns.
6. May develop, initiate, maintain and revise compliance policies and procedures.
7. Understands and adheres to Thrive Behavioral Health compliance standards as they appear in Thrive Behavioral Health Corporate Compliance Policy, Code of Conduct and Conflict of Interest Policy.
8. Stays aware of all pertinent federal, state and Thrive Behavioral Health regulation, laws, and policies as they presently exist and as they change or are modified.
9. Works with the leadership team to interpret COMAR, Joint Commission and related regulatory guidelines and develops policies and procedures that operationalize these requirements.
10. Communicates regularly and consults with Program Director and/or CEO regarding any suggestions, issues, concerns, and/or needs.
11. Responds to incidents of suspected compliance violations by evaluating or recommending the initiation of investigative procedures and takes appropriate actions as approved by the Chief Executive Officer.
12. Communicates with supervisory team regarding compliance-related matters as appropriate.
13. Supports Compliance Manager in preparing reports for senior management and external regulatory bodies as appropriate.
14. Serves as leader and spokesperson for compliance within the organization. This includes performance improvement outcomes measurement, and data analysis as well as identifying problems, assessing the causes, and taking measures to rectify the issues.
15. 15. Attends all licensing visits and surveys.
16. In response to site visit and survey recommendations, will support the Compliance Manager in the preparation of any necessary Performance and/or Quality Improvement Plans.
17. Collects and analyzes quarterly performance outcome data and narrative reports from all programs.
18. Auditing and Monitoring: Reviewing medical records and billing documents for accuracy against payer guidelines.
19. Regulatory Adherence: Ensuring compliance with HIPAA and other healthcare laws.
20. Staff Education: Training clinical and billing staff on coding updates and compliance policies.
21. Risk Management: Identifying, investigating, and reporting billing errors or fraudulent activity.
22. Under supervision of Program Director, will provide coverage for Compliance Manager as needed. 
23. Performs other duties as assigned.

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES:

• Knowledge of industry standards: organization, theory, principles, and research processes, accreditation and regulatory standards.
• Proficient knowledge of COMAR and Joint Commission regulations, principles and practices.
• Able to work effectively with management to address and implement policies and procedures that align with COMAR,HIPAA, and Joint Commission requirements.
• Knowledge of PC software programs, including Microsoft Word, Excel and Outlook is preferred.
• Effective written and oral communication skills.
• Ability to concentrate on work amid distractions such as noise, conversations and foot traffic.
• Must be able to work independently with little direct supervision in an unstructured environment with multiple demands.
• Must have a reading and writing level that can understand and clearly express complex concepts, assessments, directions and processes or sequences of events.
• Capability to represent the program well in interactions both inside and outside the facility.
• Understanding: code of ethics for respective profession and seeks consultation with supervisor when necessary.
• Professional readiness: Issues related to self-awareness, diversity, ethics and continuing education.
• Be fully aware of all facility programs, their eligibility requirements, competencies and strengths.
• Has the ability to consistently consult with supervisor when necessary and works as a team.
• Skilled in exercising a high degree of initiative, judgment, discretion, and decision-making to achieve organization’s mission.
• Ability to establish a vision, articulate the vision and execute it with success.
• Ability to identify trends and motivate workforce toward changes needed to adopt and remain competitive.
• Skilled at researching, data collection, manipulation and reporting skills.
• Able to identify opportunities for improvement and effectively plan, implement and manage assigned programs and functions.
• Accurately analyzes, interprets and evaluates complex administrative and technical issues and data and make appropriate recommendations for action.
• Establishes and maintains effective working relationships with individuals at all levels of the organization.
• Must be organized, flexible, and able to demonstrate self-motivation and prioritization.
• Ability to represent the program well in interactions both inside and outside the facility in person and over the telephone.

COMPETENCIES

• Responds to incidents of suspected compliance violations by evaluating or recommending the initiation of investigative procedures and takes appropriate actions as approved by the Chief Executive Officer.

• Ensures that staff who furnish medical/clinical or direct care services to the organization are aware of requirements of the compliance program with respect to their job duties and responsibilities.

• Possesses high integrity and the ability to communicate with diverse personalities.

• Participates as a team member in identifying healthcare disparities for the population served and assists in activities to reduce health care disparities within the agency.

• Maintains confidentiality and demonstrates the ability to handle sensitive documents and client health information in accordance with law and regulations.

• Ability to review relevant documents, perform, and coordinate an organization-wide audit, and review all areas of possible noncompliance within the organization.

MISSION STATEMENT

The mission of Thrive Behavioral Health is to provide quality mental health services to individuals and families with a focus on reducing traditional barriers to accessing treatment and ensuring a high level of collaboration with our community partners.

We are committed to treating patients and their families with the highest regard and respect for patients to work toward reaching their highest growth potential in their therapeutic process. This is accomplished through the strict adherence to the highest ethical standards of care and policies and procedures set forth by the Maryland State

Department of Health and the Joint Commission.

• Thrive Behavioral Health ensures all clients are treated with compassion, respect, and dignity regardless of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors.

• Thrive Behavioral Health employees are competent and responsible personnel who adhere to a strict code of professional ethics which include but are not limited to the prohibition of fraternization with patients, exploitation of patients, or any criminal behaviors.

• Thrive Behavioral Health provides clients with accurate and complete information regarding the available services including the program rules, regulations, goals and objectives of the program.

• Thrive Behavioral Health provides appropriate provision or referral to alternative treatment modalities is made at any time before, during, or after treatment if they are requested or the client’s needs are out of the scope of our practice.

• Thrive Behavioral Health will ensure that discharge from treatment is conducted in accordance with Maryland COMAR and the Joint Commission standards.

• Thrive Behavioral Health adheres to both COMAR and Joint Commission environment of care standards.

• Thrive Behavioral Health will take all necessary and appropriate measures to maintain individual client records and information in a confidential and professional manner.

• Thrive Behavioral Health strives to maintain positive relations with the surrounding community and pursues every reasonable action to encourage responsible behaviors and community safety.

Required Skills and Qualifications

• Experience:  1–5+ years in medical billing, coding, or auditing.
• Knowledge: Strong understanding of behavioral health CPT, HCPCS, and ICD-10 coding.
• Certifications: Certifications such as Certified Professional Biller (CPB) or Certified Professional Coder (CPC) are highly valued.

MINIMUM JOB REQUIRMENTS

Education, Training, and Experience Required:

1. Bachelor's degree in business administration, health care administration or related field. Master's degree preferred. (Significant relevant experience could replace the educational requirement).

2. Three (3) years’ of industry related experience in health care with at least three (1) years in healthcare corporate compliance, preferred.

3. Prefer CPR/First Aid Certification.

PHYSICAL DEMANDS/WORKING CONDITIONS:

• The essential functions of this job include the following physical and intellectual demands:

o Frequently sit, stand, and or walk

o Frequently hearing, seeing and speaking

o Regularly typing

o Occasionally lift and/or move up to 25 pounds

o The ability to work in a fast-paced environment with potential for stressful situations

o Comprehends and performs job duties at a reasonable pace while using attention to detail

o Concentrates, formulates plans, and makes decisions

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Due to the nature of the industry, working in the evenings, approximately 7:30-8:00 pm, may be expected.

EEOC STATEMENT: 

It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60_1.4(a), 60-300.5(a) and 60-741.5 (a), prohibiting discrimination against qualified individuals based on their race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors.