Compliance Specialist (Clinical)

Responsibilities

• Timely and accurate response to governmental audits for hospice and homecare
• Prepare and track appeals processes
• Assist with the development and implementation of a comprehensive compliance audit program
• Develop audit frameworks, methodologies, and policies aligned with regulatory requirements and best practices
• Ensure thorough documentation and reporting of audit findings with corrective action recommendations

Requirements

• 2–5 years of healthcare compliance, clinical auditing, utilization review, or medical record review experience, preferably with hospice and home health
• Strong understanding of Medicare requirements, Conditions of Participation, eligibility, billing requirements, and documentation standards
• Experience with Medicare ADRs, TPEs, pre-claim or post-payment audits, hospice eligibility, F2F/CTI requirements, interdisciplinary documentation, and claim review