Compliance Specialist

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Compliance Specialist

Compliance Specialists provide the full scope of advanced professional level support to the Chief and Regional Compliance Officer. Conducts various audits and investigations in accordance with AdaptHealth’s corporate compliance program. Identifies compliance issues, gaps in adherence of our standards, and reported issues. Additionally, should function in an advisory and consultative capacity to foster our culture of compliance. The Compliance Specialist will serve as a resource to others across the organization as well as leads investigations as necessary.

Job Duties:

• Conducts internal and external audit while adhering to audit schedules, including traveling to local sites to conduct audits and promoting the AdaptHealth compliance program
• Collaborates with the leadership team of designated region, ensure compliance objectives are met
• Provide compliance guidance and support regarding clarification of compliance requirements, accreditation standards
• Participates in investigations of identified issues, gaps in adherence of our standards, and reported issues
• Perform internal audits including, but not limited to on site reviews for compliance to HIPAA, Medicare, State, and accreditation requirements and post-payment claims reviews
• May lead compliance investigations, mapping out strategy, approach, and after assessing facts and data, make a recommendation to the Chief Compliance Officer as to resolution
• Document investigation results in a comprehensive, factual, and appropriate manner including rationale of findings and recommendations
• Travel to branch locations as needed provide compliance support, conduct site audits and investigations
• Assist operation managers and other business leaders in the development and execution of action plans for improvement and corrective/preventative action as necessary to address any deficiencies
• Respond promptly and appropriately to all requests for assistance with compliance related matters, and function in a consultative, guiding capacity
• Maintains awareness of when escalate issues of suspected non-compliance or items needing additional clarification or immediate attention from an executive
• Research and respond to questions from supervisors and other employees regarding specific Medicare and other healthcare issues on a case-by-case basis
• Ensure audit tracking is updated and changed per any process changes within AdaptHealth or per any criteria changes with Medicare/healthcare guidelines
• Contact Medicare and other insurance carriers as needed for additional information regarding claim audits
• Develop and maintain working knowledge of current HME products and services offered by the company
• Maintains an understanding of Medicare and Medicaid criteria claims filing requirements, Medicare Supplier Standards, and accreditation requirements
• Maintain patient confidentiality and function within the guidelines of HIPAA
• Completes assigned compliance training and other educational programs as required
• Maintains compliant with AdaptHealth’s Compliance Program
• Perform other related duties as assigned

Competency, Skills, and Abilities:

• Knowledge of Medicare, Medicaid, and commercial health plan reimbursement and regulatory requirements.
• Expert written and verbal communication skills
• Strong interpersonal skills
• Ability to prioritize tasks and manage multiple projects
• Strong analytical and problem-solving skills with attention to details
• Proficient use of Microsoft Office Suite – Excel, Word, Outlook, and PowerPoint
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction
• Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.

Minimum Job Qualifications:

• Associates degree from an accredited college is required; Bachelor’s degree preferred
• Three (3) years of compliance or quality assurance experience is required
• Experience Medicare, Medicaid, and third-party insurance related experience preferred
• DME related experience preferred

AdaptHealth is an equal opportunity employer and does not unlawfully discriminate against employees or applicants for employment on the basis of an individual’s race, color, religion, creed, sex, national origin, age, disability, marital status, veteran status, sexual orientation, gender identity, genetic information, or any other status protected by applicable law. This policy applies to all terms, conditions, and privileges of employment, including recruitment, hiring, placement, compensation, promotion, discipline, and termination.