Compliance Review Specialist

Primary Responsibilities And Essential Functions Of Position

• Conduct record reviews (manual and electronic) to ensure compliance with Heartshare policy, Medicaid, OPWDD, DOH, OMH, and ACS regulatory and quality standards.
• Schedule and complete clinic case record reviews, ensuring all encounters, notes, and assessments are accurate, complete, and aligned with treatment plans.
• Conduct Children’s Community Residences (CCR) and Medicaid Billing case record reviews, ensuring documentation is thorough, compliant, and audit ready.
• Monitor for documentation discrepancies, including duplications and potential fraudulent entries.
• Generate audit reports and track corrective actions to ensure ongoing compliance and effectiveness.
• Participate in state and federal audits as a support and liaison for the program.

Billing Compliance & OMIG Oversight

• Conduct Office of Medicaid Inspector General (OMIG) billing reviews for clinic and CCR programs to ensure all claims meet regulatory requirements and are billed timely.
• Identify discrepancies and coordinate necessary follow-up actions, including self-disclosures.
• Complete monthly self-disclosures for voided claims in collaboration with the Billing Compliance Officer.
• Work with program teams to review billing practices and gather documentation for compliance review.

Reporting & Quality Improvement

• Run and analyze reports on program compliance with corrective action and performance improvement plans.
• Provide recommendations to improve program performance and reduce risk based on audit outcomes and identified trends.
• Track and monitor corrective actions to ensure timely resolution and sustained compliance.

Training, Safety & Program Support

• Provide staff training on compliance standards, and best practices.
• Support programs in maintaining compliance with all applicable rules, regulations, and agency policies.

Additional Responsibilities

• Serve on committees assigned relevant to agency compliance.
• Respond to leadership requests in a timely and professional manner.

Benefits

At HeartShare we offer a comprehensive benefit package based on full-time/part-time status. You can expect:

• Rewarding Work in a team environment.
• Paid vacation, sick, personal days, and holidays.
• 403(B) retirement plans with employer contribution.
• Health, dental, vision and life insurance.
• Employee Assistance Program (EAP).
• Flexible spending account (Dependent Care, Medical, Parking, and Transit).
• Employee Appreciation Programs and Events.
• Tuition Assistance Program.
• Professional Development opportunities.
• Wellhub Discount, Verizon Wireless Discount, BJs Membership discount.
• Discounts on Broadway tickets, movie tickets, theme parks, sporting events, gift certificates & more.

About Heartshare

For over 150 years, Heartshare has been dedicated to championing and empowering New Yorkers society has too often overlooked and underestimated. To learn more about HeartShare, please visit our website at www.heartshare.org or Follow us on Twitter, LinkedIn, YouTube, Instagram, and Facebook.