Health Home Quality & Compliance Specialist

CareCollab; New York (NY); On-site; USD 90,000 - 120,000; Full time

Job summary

CareCollab is seeking a Quality Improvement & Compliance Specialist to drive quality assurance, compliance, and continuous improvement across Health Home programs in New York. The role oversees chart auditing, pre-bill quality review, enrollments, and corrective action, translating audit findings into sustainable processes.

The ideal candidate understands New York Medicaid Health Home requirements and collaborates with clinical and operational leaders to improve quality and prevent recurring

Qualifications

• 3+ years of experience in New York Medicaid Health Home care management.
• Hands-on experience with MAPP and Health Home record systems; FCM experience preferred.
• Experience conducting Lead Health Home chart audits and related activities.
• Working knowledge of enrollment, consent, diagnosis verification, core services, billing, diligent search, and care plans.

Responsibilities

• Lead quarterly Lead Health Home chart audits and internal audits across teams.
• Evaluate documentation against Lead Health Home standards and identify trends and risks.
• Perform pre-bill reviews to ensure months are supported by appropriate services and docs.
• Coordinate corrections for non-compliant member months and enrollments for completeness.
• Audit new enrollments for completeness and required documentation.
• Review care management documentation including assessments, care plans, and continued eligibility.
• Produce monthly quality reports on audits, billing holds, corrective actions, and trends.
• Partner with leaders to address quality issues and implement corrective actions.
• Turn recurring findings into sustainable controls (checklists, fields, reviews, workflows).
• Maintain quality workflows and guidance as NY requirements evolve.
• Coordinate Performance Improvement Plan activities and other corrective actions.
• Serve as internal expert on Health Home quality and compliance.
• Develop and deliver training based on audit findings and trends.
• Escalate significant or unresolved compliance concerns to leadership.

Skills

Quality improvement

Audit coordination

Communication

Root cause analysis

Documentation standards

Education

Registered clinical background

Tools

MAPP

Health Home record system

Job description

CareCollab is seeking a Quality Improvement & Compliance Specialist to drive quality assurance, compliance, and continuous improvement across Health Home programs in New York. The role oversees chart auditing, pre-bill quality review, enrollments, and corrective action, translating audit findings into sustainable processes.

The ideal candidate understands New York Medicaid Health Home requirements and collaborates with clinical and operational leaders to improve quality and prevent recurring