Compliance Specialist

America's Home Health Services•Pittsburgh, PA

About The Position

America’s Home Health Services is seeking a highly organized, detail-oriented, and proactive Compliance Specialist to oversee and maintain the agency’s day-to-day regulatory compliance and audit-readiness program. The Compliance Specialist is responsible for ensuring that America’s Home Health Services is audit-ready 100% of the time. This position will monitor employee, Direct Care Worker (DCW), Direct Support Professionals (DSP), client/patient, branch, licensing, training, EVV, and operational compliance requirements and ensure that all required documentation is complete, current, properly maintained, and readily available for review. This is not a position where compliance is reviewed only when an audit occurs. The expectation is that every employee file, client file, branch file, license, credential, training record, EVV report, and required regulatory document is maintained continuously at a level that would allow the agency to respond confidently to an audit or survey at any time. The Compliance Specialist will work closely with Human Resources, Recruiting, Operations, Clinical, Scheduling, Payroll, Billing, Branch Leadership, Client Services, and Executive Leadership to identify compliance issues before they become deficiencies. The successful candidate must be comfortable holding departments accountable, following up on missing documentation, establishing deadlines, escalating unresolved issues, and working collaboratively with teams to correct deficiencies.

Requirements

Experience with Pennsylvania home care.
Experience with Pennsylvania Medicaid waiver programs.
Strong knowledge of Pennsylvania healthcare regulatory requirements.
Experience with OLTL.
Experience with ODP.
Experience with Department of Health surveys.
Experience with EVV.
Experience with HHA/EVV systems.
Experience preparing for Medicaid or payer audits.
Experience developing compliance training.
Experience with quality assurance/performance improvement programs.
Experience with employee credentialing and personnel files.
Experience with background checks and employee clearances.
Experience with TB/health screening documentation.
Experience with audits and regulatory compliance.
Strong organizational skills.
Exceptional attention to detail.
Ability to manage large volumes of documentation.
Ability to meet strict deadlines.
Strong written and verbal communication skills.
Ability to work independently while collaborating with multiple departments.
Strong computer and Microsoft Office skills.
Ability to maintain confidential information.
Ability to identify compliance risks before they become deficiencies.

Nice To Haves

Extremely detail-oriented.
Organized.
Persistent.
Accountable.
Proactive.
Ethical.
Confidential.
Professional.
Comfortable enforcing standards.
Comfortable communicating with leadership.
Comfortable holding team members accountable.
Calm under pressure.
Solution-oriented.
Strong at follow-through.
Able to prioritize high-risk compliance issues.
A strong communicator and team player.

Responsibilities

Maintain a continuous state of audit readiness.
Conduct routine and scheduled internal compliance audits.
Identify missing, expired, incomplete, or inconsistent documentation.
Establish corrective action deadlines.
Follow up with responsible departments until deficiencies are corrected.
Escalate unresolved compliance issues to management.
Maintain documentation of corrective actions.
Prepare the agency for Pennsylvania Department of Health, DHS, OLTL, ODP, payer, EVV, Medicaid, and other regulatory or program audits.
Maintain organized electronic and/or physical compliance records.
Ensure that required documentation can be located quickly when requested.
Develop and maintain compliance checklists, tracking reports, expiration calendars, and audit tools.
Continuously monitor regulatory changes that may affect the agency.
Oversee the compliance approval process for all Direct Care Workers and other applicable employees, verifying and approving required documentation before an employee is permitted to provide services.
Monitor client admission documentation, required assessments, Medicaid/waiver documentation, service plans, Plan of Care documentation, authorized hours/units, approved service types, client eligibility documentation, required signatures, required consents, physician/clinical documentation, client rights documentation, emergency contact documentation, emergency plans, required notices, service start-date requirements, caregiver/client matching requirements, and documentation necessary for billing and audit purposes.
Monitor TB screening requirements, verify baseline TB documentation, track expiration or renewal requirements, identify employees with missing or expired documentation, prevent assignment of individuals who are not compliant with required screening requirements, maintain confidential health-related documentation appropriately, and conduct outreach to field staff members to keep them in compliance.
Maintain a comprehensive regulatory calendar covering all licenses, registrations, certifications, renewals, applications, notices, and required submissions applicable to America’s Home Health Services, including monitoring requirements associated with Pennsylvania Department of Health (Home Care Agency licensing, Home Health Agency licensing, Branch/location licensing, License renewals, Change of ownership documentation, Administrator/point-of-contact changes, Required agency updates, Survey preparation, Plans of correction, Regulatory correspondence, Department of Health requests, Required postings and documentation, Applicable facility/licensure records), DHS/OLTL (Maintain compliance documentation and monitoring related to applicable Office of Long-Term Living programs, waivers, provider requirements, and authorizations), ODP (Maintain compliance requirements related to the Office of Developmental Programs, including applicable provider qualifications, employee requirements, training, documentation, and program-specific compliance), and Other Pennsylvania Programs (Monitor applicable requirements involving Medicaid, Waiver programs, Managed Care Organizations, Program-specific provider requirements, County/program requirements, Payer credentialing, EVV requirements, and Other governmental or contracted programs applicable to the agency).
Maintain a master licensing and branch compliance file for every America’s Home Health Services location, including current licenses, license expiration dates, applications, renewal documentation, Administrator/branch leadership information, required regulatory postings, required policies and procedures, inspection/survey documentation, corrective action plans, branch-specific compliance requirements, program-specific approvals, correspondence with regulatory agencies, and documentation of required changes or notifications.
Oversee the agency's Electronic Visit Verification (EVV) compliance monitoring and reporting process, including monitoring EVV compliance, reviewing EVV exception reports, coordinating corrections with Operations and Scheduling, working with Payroll and Billing when EVV issues affect payroll or claims, maintaining EVV compliance reports, monitoring EVV submission requirements, ensuring corrective actions are documented, tracking recurring EVV issues by employee, client, branch, or department, and training employees and management on EVV expectations.
Conduct routine audits of personnel files to ensure that 100% of required employee documentation is present and current, including new-hire documentation, background checks, Child Abuse Clearances, FBI documentation, Residency verification, TB screening, Certifications, Licenses, Training, Competency, Orientation, Required acknowledgements, Employee evaluations, Annual requirements, Expiring credentials, and Program-specific documentation.
Conduct routine audits of client/patient records for required admission documentation, service authorizations, service plans, consents, required signatures, eligibility documentation, service hours, authorization utilization, required assessments, required notices, caregiver assignments, EVV documentation, required clinical documentation, and billing-supporting documentation.
Develop and deliver compliance education, including new employee training on agency policies, compliance expectations, documentation standards, EVV, confidentiality, HIPAA, client rights, abuse/neglect reporting, incident reporting, infection control, employee responsibilities, documentation requirements, program-specific requirements, and audit expectations. Develop an annual compliance training calendar and provide ongoing training to DCW/DSPs, Coordinators, Recruiters, Branch managers, Clinical staff, Supervisors, Scheduling staff, Billing staff, Payroll staff, and Administrative staff.
Serve as a key resource during Pennsylvania Department of Health surveys, DHS/OLTL reviews, ODP reviews, Medicaid audits, Payer audits, EVV audits, Internal compliance audits, Complaint investigations, Record requests, and Other regulatory reviews. Responsibilities include preparing requested records, coordinating responses, organizing supporting documentation, tracking requests, maintaining an audit-request log, coordinating with department leaders, tracking deadlines, preparing corrective action documentation, monitoring plans of correction, and verifying corrective actions have been implemented.
Provide regular reporting to Executive Leadership, which may include employee compliance percentage, personnel file audit results, client file audit results, TB compliance, background-check compliance, credential expiration report, training compliance, EVV compliance, branch licensing status, open deficiencies, corrective action status, overdue compliance items, upcoming regulatory deadlines, repeat deficiencies, and high-risk compliance issues.
Continually improve the agency's compliance infrastructure by creating and maintaining compliance checklists, employee compliance checklists, client compliance checklists, branch compliance checklists, licensing calendars, credential expiration trackers, training trackers, audit trackers, corrective action trackers, EVV dashboards/reports, regulatory calendars, internal audit schedules, compliance dashboards, standard operating procedures, and audit-response procedures.