Clinical Compliance Specialist

VITRA Health • Boston, MA

6d

About The Position

Vitra Health is a mission-driven healthcare organization committed to improving the quality of life for individuals and families across Massachusetts. Through innovative home- and community-based services, Vitra supports aging adults, people with disabilities, and individuals with complex care needs— supported by a Nurse, and Case Manager, Vitra ensures clients receive compassionate, personalized, and dignified care. To help share our mission and expand our community impact, Vitra Health is seeking a Compliance Specialist who is passionate about community engagement and helping people access the care and resources they deserve. The Opportunity As a Clinical Compliance Specialist with Vitra Health’s, you will support the day-to-day operations of the Compliance Department by helping maintain regulatory and accreditation standards across the organization. The role supports clinical quality & compliance by engaging in monitoring and developing activities to enhance healthcare delivery standards. This role plays a key part in promoting a culture of compliance by ensuring timely communication, accurate documentation, and effective follow-through on compliance initiatives. The ideal candidate is mission-minded, detailed oriented, highly organized, and able to maintain the confidentiality of sensitive information.

Requirements

• Degree in nursing required.
• Active RN license in the state of Massachusetts.
• Minimum of two years of experience in healthcare compliance, regulatory affairs, or a similar role required.
• Experience reviewing documentation, claims, or billing processes in a regulated environment
• Familiarity with healthcare regulations including HIPAA, CMS, NCQA, and OIG guidelines strongly preferred.
• Strong command of Microsoft Excel and Microsoft PowerPoint.
• Strong organizational, analytical, and communication skills.
• Ability to manage confidential and sensitive information with integrity and discretion.
• Potential for occasional travel between office locations, especially during external audits or inspections.

Nice To Haves

• Certifications in one or more of the following preferred: Certified in Healthcare Compliance (CHC) Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or willingness to obtain in 6 months.
• Experience with electronic medical records, learning management systems, compliance tracking tools, or risk management platforms preferred.

Responsibilities

• Compliance Program Support: Support the Compliance Officer and Compliance Manager in implementing and maintaining the organization’s compliance program and compliance workplan
• Monitor regulatory changes and assist with updates to policies, procedures, and internal controls
• Maintain compliance documentation, tracking tools, and audit logs
• Support internal and external audits, reviews, and regulatory inquiries
• Track and assist with preparing external compliance reports to regulators, payers, and accreditation bodies.
• Lead or coordinate compliance-related tasks related to healthcare delivery and field staff including engaging with clients to check quality of care coordination and client visits.
• Monitoring, Risk Assessment & Review: Execute risk-based monitoring across clinical documentation and service delivery
• Identify and prioritize regulatory risk areas within AFC, GAFC, and ADH programs
• Perform periodic and targeted reviews of medical records
• Maintain clear, organized workpapers to support review activities
• Performs visits (remote and onsite) to ensure continuity of service and documentation are aligned with compliance and quality standards
• Engage with caregiver to assess effectiveness and presence of required education
• Serves as educator to field staff to assess risk and gaps in required education
• Periodically review care teams files to ensure alignment with program requirements
• Monitors qualitative and quantitative requirements of client visits and caregiver logs
• Reviews care teams compliance requirements in alignment with Vitra’s compliance plan
• Document and communicate findings in clear, actionable reports to compliance team and ops management
• Assess and classify issues based on risk and regulatory impact
• Escalate significant concerns in accordance with established protocols
• Maintain training records and assist in developing or updating training materials.
• Support cross-functional teams in preparing for audits and responding to surveyor requests
• Foster culture of customer service and commitment to quality care.
• Serve as a brand ambassador for Vitra reflecting our vision, mission, and values.
• Show genuine interest and compassion for the communities we serve and commitment to the diversity of our clients and team members.

Benefits

• Employer sponsored health Insurance with a generous employer match.
• Dental and Vision Benefits.
• Supplemental Benefits Life, Accident, Critical Illness and Disability Insurance.
• 401K with a 5% company match.
• Accrued Paid-Time-Off.
• Ten company paid holidays.
• Wellness Benefits.
• Tuition Reimbursement.
• Supportive team structure and company culture with a focus on work/life balance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 11-50 employees