Quality & Compliance Specialist

Acumen LLC•Mesa, AZ

10d•$55,000 - $65,000

About The Position

The Quality and Compliance Specialist supports the organization’s day-to-day quality and compliance operations, monitors contractual and regulatory requirements, and supports continuous improvement efforts across programs and departments. The role includes conducting audits and investigations, planning corrective actions, reporting, supporting staff, and tracking compliance activities while promoting accountability, quality improvement, and operational excellence. It requires analytical, organizational, project management, and leadership skills and the ability to manage multiple priorities in a fast-paced environment.

Requirements

Bachelor’s degree in public policy, social sciences, business administration, healthcare administration, or a related field, or an equivalent combination of education and experience.
At least 2 years of experience in quality compliance, auditing, healthcare administration, Medicaid programs, or a related field.
Previous experience coordinating audits, compliance reviews, corrective action plans, or regulatory reporting activities.
Knowledge of Medicaid, state, and federal regulations and contractual compliance requirements.
Strong project management, organizational, analytical, and problem-solving skills.
Ability to manage multiple priorities and deadlines with limited supervision.
Excellent written and verbal communication skills.
Strong attention to detail and ability to maintain confidentiality.
Experience using Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint.
Ability to learn and become proficient in Acumen-specific systems and programs.
Valid driver’s license in the state of residence and valid automobile insurance.

Nice To Haves

Experience conducting Medicaid audits and regulatory reviews.
Experience with quality improvement methodologies and process improvement tools.
Knowledge of HIPAA requirements and healthcare compliance standards.
Experience analyzing data, identifying trends, and presenting findings to leadership.
Experience developing or facilitating staff training programs.
Previous experience in social services, healthcare operations, or managed care environments.

Responsibilities

Maintain a detailed understanding of current AFA contracts, provider manuals, policies, and applicable state and federal regulations.
Serve as a subject matter resource on contract compliance, program requirements, and quality assurance processes.
Liaise with Program Managers, Executive Directors, Operations teams, and other departments to resolve compliance concerns, contractual issues, audit findings, and operational risks.
Assist with implementing and overseeing quality compliance programs, systems, and initiatives across the organization.
Coordinate and oversee internal and external audits, Requests for Information (RFI), subpoenas, surveys, and regulatory reviews.
Facilitate cross-department collaboration to compile accurate and timely audit documentation while maintaining HIPAA and contractual compliance.
Review audit findings, identify trends and risks, and recommend quality improvement initiatives to leadership.
Monitor and oversee complaint tracking, investigations, trend analysis, and escalation processes.
Support departments in developing and implementing corrective and preventative action plans to resolve compliance and quality concerns.
Research, analyze, and communicate changes in legislation, regulations, contracts, and program requirements that may affect operations or organizational compliance.
Assist in developing, implementing, and maintaining policies, procedures, forms, reporting tools, and internal controls that support compliance objectives.