Quality & Compliance Specialist

Description
POSITION SUMMARY The Quality and Compliance Specialist will support the organization’s compliance day-to-day quality and compliance operations, monitor contractual and regulatory requirements, and support continuous improvement efforts across programs and departments.
The Quality and Compliance Specialist is also responsible for conducting audits, investigations, corrective action planning, reporting, staff support, and compliance tracking activities while promoting a culture of accountability, quality improvement, and operational excellence. This position requires strong analytical, organizational, project management, and leadership skills, as well as the ability to manage multiple priorities in a fast-paced environment.
Qualifications
Bachelor’s degree in public policy, Social Sciences, Business Administration, Healthcare Administration, or related field; or equivalent combination of education and experience
Minimum of 2 years of experience in quality compliance, auditing, healthcare administration, Medicaid programs, or 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 all Acumen-specific systems and programs
Valid driver’s license within state of residence and valid automobile insurance
Preferred Qualifications
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
Requirements
ROLE AND ESSENTIAL FUNCTIONS
Maintain detailed understanding of all current AFA contracts, provider manuals, policies, and applicable State and Federal regulations
Serve as a subject matter resource regarding contract compliance, program requirements, and quality assurance processes
Act as a liaison between Program Managers, Executive Directors, Operations teams, and other departments to resolve compliance concerns, contractual issues, audit findings, and operational risks
Assist with the implementation and oversight of 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 compliance with HIPAA and contractual requirements
Review audit findings, identify trends and risks, and provide recommendations to leadership to support quality improvement initiatives
Monitor and oversee complaint tracking, investigations, trending 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 impact operations or organizational compliance
Assist in the development, implementation, and maintenance of policies, procedures, forms, reporting tools, and internal controls to support compliance objectives
#Acumen

Skills
Excel, Project Management, Process Improvement, Auditing, Documentation

Experience
2+ yrs

Work arrangement
Yes