Healthcare Compliance Specialist

Job Summary

The Healthcare Compliance Specialist supports Essen Healthcare’s commitment to delivering high-quality, compliant patient care by ensuring adherence to federal, state and payer regulations. This role conducts audits, monitors operational processes, identifies compliance risks and collaborates across divisions to implement corrective action plans.

Responsibilities

• Conduct routine and targeted compliance audits across clinical and administrative areas (documentation, coding, billing, regulatory processes, policy adherence, etc.)
• Review patient care workflows in medical offices and identify gaps or opportunities for improvement
• Monitor regulatory updates and ensure organizational policies and procedures are aligned with federal, state and payer requirements
• Work collaboratively with clinical leadership, operations, quality and IT to support corrective actions, training and process improvement initiatives
• Utilize EMR systems and BI reporting tools to analyze data, measure compliance trends and prepare reports for leadership
• Investigate potential compliance issues, support incident follow-up and maintain documentation on outcomes and resolutions
• Serve as a resource to staff and leadership on compliance-related issues and best practices
• Assist with development and delivery of compliance education and training programs

Requirements

• Bachelor’s degree required. Master’s degree preferred
• RN strongly preferred
• RN-BSN preferred
• RN Associate Degree acceptable
• Minimum 2 years of direct patient care experience required
• Demonstrated understanding of medical office patient care workflows
• Experience with EMR systems and/or business intelligence (BI) reporting tools
• Prior experience in Healthcare Compliance and/or audit functions strongly preferred
• Experience communicating with clinical, operational, and executive leadership

Qualifications

• Strong analytical and problem-solving skills
• Ability to function independently with minimal supervision
• Excellent verbal and written communication skills
• Ability to collaborate across diverse teams and departments
• High attention to detail and strong organizational skills
• Working knowledge of HIPAA, CMS regulations, state regulations, and payer compliance requirements

Benefits

Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.