The primary responsibility of the Compliance Specialist is to review clinical medical records and claims for accuracy of services related to home health care. The Compliance Specialist maintains a comprehensive understanding of ethical principles and independence in their work, professional conduct, duty, and responsibilities. The Compliance Specialist is obligated to articulate principles, have a working knowledge of the rules and regulations as they pertain to all aspects of home healthcare, and observe/ensure the highest level of professional standards, quality care, and legal aspects.
Essential Duties and Responsibilities:
Reviews clinical medical records and claims for accuracy of services related to clinical standards of practice and care, levels of care, quality indicators, medical necessity, length(s) of stay, billing, and denials
Makes proposals related to compliance and continuous quality improvement
Conducts exit conferences and provides timely written feedback
Works collaboratively with Regional Operations and Site Managers
Participates in provider educational programs
Serves as a resource, providing information generated from a sound basis
Ensures confidentiality of medical information related to HIPAA regulations
Displays dedication to corporate objectives
Performs audits as scheduled by the Compliance Leadership team
Completes work product in an accurate and timely fashion as required by the Compliance Leadership team
Ensures business travel is consistent with the business objectives of the Compliance Department, and submits all expense reimbursement requests within 30 days of site visit
Assists with clinical review for claims testing activities
Assists with clinical review for issues investigation and resolution
Performs other duties as assigned/necessary
Minimum Requirements:
Active RN license required
BSN or other commensurate healthcare degree preferred
Experience in utilization review, risk management, quality management, documentation specialization, nurse management, compliance, billing, coding, or CFE, LNC, or CPUR certification preferred
At least five years of clinical experience required, preferably in Home Health
Demonstrated knowledge of clinical compliance, medical record review and legal aspects of documentation preferred
Demonstrated knowledge of CPT, ICD 10 codes, DRGs, and APC coding preferred
Understanding of payer rules and regulations, including Medicare and Medicaid preferred
Computer proficiency, including programs such as MS Office, Word, Excel, email, and internet research, required
Travel 50% - 75% of the work time may be required
Ability to effectively elicit/provide information to and from appropriate individuals (including, but not limited to, supervisors, co-workers, clients) via strong communication skills preferred
Proficiency in the English language is required
Maxim Benefits:
Health and Wellness Medical/Prescription, Dental, Vision, Health Advocacy (company paid if enrolled Medical) and Health Advocate Employee Assistance Program
Retirement and Financial Security: Employee Assistance Program, Health Savings Account, 401(k) + Company Match, Profit Sharing, Short and Long Term Disability, Primary Caregiver Leave, Parental Leave, Life and Basic Accidental Death & Dismemberment Insurance, Voluntary Group Life Insurance and Supplemental Accidental Insurance, Hospital Expense Protection Plan, Critical Illness Insurance, Dependent Care Flexible Spending Account, Home and Auto Insurance discounts, Pet Insurance and Legal benefits
Lifestyle Benefits: Paid Time Off and Company Paid Holidays, Transportation Benefits, Educational Assistance Program, College Partnership Program and Employee Discount Program
*Benefit eligibility is dependent on employment status.
About Maxim Healthcare
Maxim Healthcare has been making a difference in the lives of our patients, caregivers, employees and communities for more than 30 years. We offer private duty nursing, skilled nursing, physical rehabilitation, companion care, respite care and behavioral care for individuals with chronic and acute illnesses and disabilities. Our commitment to quality customer service, compassionate patient care, and filling critical healthcare needs makes us a trusted partner wherever care is needed.
Maxim Healthcare, Inc. (“Maxim”) is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.
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Benefits
