Compliance Specialist at AdaptHealth, Remote

Job Summary

Compliance Specialists provide the full scope of advanced professional-level support to the Chief and Regional Compliance Officer. Conducts various audits and investigations in accordance with AdaptHealth’s corporate compliance program. Identifies compliance issues, gaps in adherence of our standards, and reported issues. Additionally, it should function in an advisory and consultative capacity to foster our culture of compliance. The Compliance Specialist will serve as a resource to others across the organization as well as lead investigations as necessary.

• Duties:
  Conducts internal and external audit while adhering to audit schedules, including traveling to local sites to conduct audits and promoting the AdaptHealth compliance program
  Collaborates with the leadership team of designated region, ensure compliance objectives are met
  Provide compliance guidance and support regarding clarification of compliance requirements, accreditation standards
  Participates in investigations of identified issues, gaps in adherence of our standards, and reported issues
  Perform internal audits including, but not limited to on site reviews for compliance to HIPAA, Medicare, State, and accreditation requirements and post-payment claims reviews
  May lead compliance investigations, mapping out strategy, approach, and after assessing facts and data, make a recommendation to the Chief Compliance Officer as to resolution
  Document investigation results in a comprehensive, factual, and appropriate manner including rationale of findings and recommendations
  Travel to branch locations as needed provide compliance support, conduct site audits and investigations
  Assist operation managers and other business leaders in the development and execution of action plans for improvement and corrective/preventative action as necessary to address any deficiencies
  Respond promptly and appropriately to all requests for assistance with compliance related matters, and function in a consultative, guiding capacity
  Maintains awareness of when escalate issues of suspected non-compliance or items needing additional clarification or immediate attention from an executive
  Research and respond to questions from supervisors and other employees regarding specific Medicare and other healthcare issues on a case-by-case basis
  Ensure audit tracking is updated and changed per any process changes within AdaptHealth or per any criteria changes with Medicare/healthcare guidelines
  Contact Medicare and other insurance carriers as needed for additional information regarding claim audits
  Develop and maintain working knowledge of current HME products and services offered by the company
  Maintains an understanding of Medicare and Medicaid criteria claims filing requirements, Medicare Supplier Standards, and accreditation requirements
  Maintain patient confidentiality and function within the guidelines of HIPAA
  Completes assigned compliance training and other educational programs as required
  Maintains compliant with AdaptHealth’s Compliance Program
  Perform other related duties as assigned

Competency, Skills, and Abilities:
Knowledge of Medicare, Medicaid, and commercial health plan reimbursement and regulatory requirements.
Expert written and verbal communication skills
Strong interpersonal skills
Ability to prioritize tasks and manage multiple projects
Strong analytical and problem-solving skills with attention to details
Proficient use of Microsoft Office Suite – Excel, Word, Outlook, and PowerPoint
Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction
Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.
 

Minimum Job Qualifications:
Associates degree from an accredited college is required; Bachelor’s degree preferred
Three (3) years of compliance or quality assurance experience is required
Experience Medicare, Medicaid, and third-party insurance related experience preferred
DME related experience preferred

AdaptHealth is an equal opportunity employer and does not unlawfully discriminate against employees or applicants for employment on the basis of an individual’s race, color, religion, creed, sex, national origin, age, disability, marital status, veteran status, sexual orientation, gender identity, genetic information, or any other status protected by applicable law. This policy applies to all terms, conditions, and privileges of employment, including recruitment, hiring, placement, compensation, promotion, discipline, and termination.