Compliance Specialist - HC & Hospice (Full time, day shift)

Rochester Regional Health

1d • Onsite

About The Position

Provides and supports regulatory, accreditation and certification activities to achieve and sustain ongoing compliance. Takes action to assure timely and complete preparation, support and follow-up to surveys, reviews and investigations. Represents the organization in interfaces with regulatory and accreditation agencies. Remains current with state and federal regulations and communicates that information within the organization. Works closely with leaders to develop and implement plans to meet new or revised regulations or standards.

Requirements

• Bachelor's degree
• Minimum of 1 year experience in one or more of the following: Home Health Care OR Clinical Compliance OR Health Care Administration

Nice To Haves

• Master’s degree preferred
• Regulatory audit/survey experience in a healthcare setting
• Experience with metrics and reporting
• RN or another clinical license/certification strongly preferred
• Knowledge/understanding of laws and regulations governed by NYS and CMS

Responsibilities

• Monitor and interpret federal, state, and local healthcare regulations, including HIPAA, Medicare, Medicaid, and accreditation standards (e.g., NYS DOH). Acts as a liaison with health system regulatory partners (e.g. Corporate Compliance, Privacy Program, etc).
• Prepare and submit regulatory agency applications, reports, or correspondence ensuring compliance with applicable laws and regulations.
• Lead the agency review and response to fast-tracked discharge appeals, insurance audits, and CMS Contractor audits.
• Conduct regular audits, assessments, and performance evaluations to identify areas for improvement and monitor compliance with CMS Conditions of Participation.
• Coordinate and facilitate accreditation activities, such as accreditation surveys, readiness assessments, and corrective action plans.
• Prepare documentation and evidence for accreditation surveys and ensure compliance with accreditation standards.
• Develop and maintain the organization’s policy and procedure library. Ensure that policies are up-to-date, comprehensive, and aligned with regulatory requirements and best practices.
• Identify and assess risks to patient safety, data security, and organizational integrity. Develop risk mitigation strategies and corrective action plans to address identified risks and prevent adverse events or compliance violations.
• Provide training and education to staff on regulatory requirements and compliance standards. Collaborate with departmental leaders to develop and deliver training programs that promote a culture of quality and compliance.
• Collect, analyze, and interpret data related to compliance measures. Prepare reports, dashboards, and presentations to communicate findings and trends to leadership and stakeholders.
• Investigate incidents, complaints, and adverse events to determine root causes and contributing factors. Implement corrective actions and preventive measures to address identified issues and prevent recurrence.
• Performs other regulatory compliance duties, as assigned.

Benefits

• Integrated health services organization serving the people of Western New York, the Finger Lakes, St. Lawrence County, and beyond.
• Includes nine hospitals; primary and specialty practices, rehabilitation centers, ambulatory campuses and immediate care facilities; innovative senior services, facilities and independent housing; a wide range of behavioral health services; and Rochester Regional Health Laboratories and ACM Global Laboratories, a global leader in patient and clinical trials.
• Vision is to lead the evolution of healthcare to enable every member of the communities it serves to enjoy a better, healthier life.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level