Compliance Specialist

S:US; City of Niagara Falls (NY); On-site; USD 65,000 - 80,000; Full time

Job summary

S:US is seeking a Compliance Specialist within their QA department, positioned at 7th Avenue, New York, NY. The role focuses on Medicaid billing reviews, auditing clinical documentation, and maintaining regulatory compliance across programs.

The ideal candidate holds a Bachelor’s Degree with at least two years in healthcare or nonprofit settings, and must be willing to travel across all boroughs and work a flexible schedule.

Qualifications

• Bachelor’s Degree in a related field with minimum two years of healthcare or nonprofit experience.
• Willing to travel extensively in all boroughs.
• Flexible schedule required.

Responsibilities

• Conduct Medicaid billing reviews to ensure documentation exists to support billing.
• Review and audit the quality of clinical case documentation and services.
• Conduct site visits to ensure compliance with regulatory mandates.
• Draft investigation reports summarizing findings and recommending corrective actions.
• Develop, review, analyze and improve internal controls and monitoring systems for various programs.

Education

Bachelor’s Degree

Master’s Degree preferred

High School Diploma with 7+ years experience

Job description

Min

USD $65,000.00/Yr.

Max

USD $80,000.00/Yr.

Position Overview

SUS is seeking a Compliance Specialist within their QA department.

This position is located at 7th Avenue New York, NY 10018.

SCOPE OF ROLE

The Support Services functions at S:US are carried out by a team of professionals with differing backgrounds who share deeply in the S:US mission. We provide resources and support to the program departments to collectively pursue that mission. Support Services is a collegial, supportive and dynamic culture that continuously seeks to improve. We strive to treat all staff with respect in each interaction. We are motivated to accomplish our individual and collective tasks by the belief that we can help transform the lives of people we serve thereby righting societal imbalances.

ESSENTIAL DUTIES & RESPONSIBILITIES

Audits/Reviews

• Conduct Medicaid billing reviews to ensure documentation exists to support billing


• Review and audit the quality of clinical case documentation and services


• Conduct site visits to ensure compliance with all regulatory mandates


• Conduct follow-up audits to confirm corrective actions have been implemented and are effective


• Draft written reports summarizing findings of various audits/reviews


• Help to develop audit tools to be used in various audits/reviews

Trainings

• Conduct compliance/documentation trainings for staff


• Help to develop and update training materials for compliance/documentation trainings Compliance Investigations


• Conduct investigations regarding regulatory and compliance issues


• Draft investigation reports summarizing findings and recommending corrective actions Compliance Support


• Provide technical assistance to staff when questions arise regarding documentation requirements or other compliance related issues


• Develop, review, analyze and improve internal controls and monitoring systems for various programs/departments


• Identify compliance risk areas and assist with the development and implementation of policies and corrective action plans where indicated


• Attend inter-departmental meetings representing the quality assurance department to ensure compliance with regulatory mandates


• Attend external meetings and trainings representing the agency at various trade associations


• Perform other duties as required

KEY RESPONSIBILITIES

Communication: Ability to communicate effectively and demonstrate good interpersonal and professional skills when interacting with individuals served, co-workers, and management. Maintain open communication with your supervisor as it relates to the completion and accuracy of assignments. Listen and respond appropriately to others’ ideas, make suggestions and offer alternative solutions, and give and receive honest, constructive feedback.

Quality of Work: Assignments are accurate, complete, timely, and comply with agency and department policies and procedures. Independently work towards overcoming challenges and barriers to accomplish performance objectives. Complete an acceptable quantity of work within deadlines, while maintaining the required quality and accuracy of the work.

Integrity/Compliance: Uphold personal and professional ethics and values, considering the values of the organization and respecting the culture, beliefs and abilities of individuals we Ensure compliance with HIPPA and other regulatory requirements for responsible areas, as well the completion of all assigned trainings.

Teamwork: Encourage team unity through sharing information/expertise, working together to solve problems, and putting team success first. Attend and participate in departmental and team meetings.

Self-Motivated/Flexible: Demonstrate initiative and endeavor to maintain a stable level of productivity. Demonstrate the ability to multitask and balance competing priorities, work with minimal supervision, and exercise sound, practical judgment and problem-solving skills. Easily adjust to changes in routine, assignments, and agency/client needs while continuing to be productive.

Job Knowledge: Demonstrate skills and knowledge relevant to job functions. Apply current best practices and maintain awareness of major developments in your specialty area. Demonstrate expertise in relevant regulatory requirements.

Writing: Convey ideas and facts in writing using language the reader will best understand. Use correct vocabulary, spelling, grammar, and punctuation. Present information clearly, concisely, and logically for the intended audience.

Qualifications

REQUIREMENTS:

REQUIRED QUALIFICATIONS

• Bachelor’s Degree: Required in a related field, together with a minimum of two (2) years of experience in the healthcare or nonprofit field.


• Must be willing to:


• Travel extensively in all of the boroughs


• Work a flexible schedule in order to meet the needs of the department.

PREFERRED QUALIFICATIONS

• Master’s Degree preferred.


• Audit experience preferred.


• In lieu of Bachelor’s Degree, High School Diploma or equivalent with minimum of seven (7) years of experience in the healthcare or non-profit field.

Company Overview

S:US IS AN EQUAL OPPORTUNITY EMPLOYER

Join a team of employees who care about the wellbeing of others. We believe in fostering a culture built on our core values: respect, integrity, support, maximizing individual potential and continuous quality improvement. From health and wellness resources to generous PTO, professional development, and more, explore all that we offer on our Benefits Page and see how S:US invests in you.

We believe in fostering a culture built on our core values: respect, integrity, support, maximizing individual potential and continuous quality improvement.

All qualified applicants will receive consideration for employment without regard to race, color, religion, disability, age, sexual orientation, national origin, veteran status, or genetic information and including all other statuses protected by Federal, State and Local laws. S:US is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities, including allowance of the use of services animals. To request reasonable accommodation or if you believe such a request was improperly handled or denied, contact the Leave Team at [e-mail].

ID

2026-18970

Work Location

In Person