Compliance Specialist - Homecare & Hospice (Full time, day shift) in ROCHESTER, New York at Rochester Regional Health

Job Title: Compliance Specialist - Homecare & Hospice
Department: Home Care & Hospice
Location: 330 Monroe Ave Rochester, NY 14607
Hours Per Week: 40 hours per week

Schedule: 8:30AM-5:00PM Monday through Friday

Job Profile Summary

Position Summary:
Provides and supports regulatory, accreditation and certification activities to achieve and sustain ongoing compliance. Takes action to assure timely and complete preparation, support and follow-up to surveys, reviews and investigations. Represents the organization in interfaces with regulatory and accreditation agencies. Remains current with state and federal regulations and communicates that information within the organization. Works closely with leaders to develop and implement plans to meet new or revised regulations or standards.
Key Responsibilities:
• Regulatory Compliance: Monitor and interpret federal, state, and local healthcare regulations, including HIPAA, Medicare, Medicaid, and accreditation standards (e.g., NYS DOH). Acts as a liaison with health system regulatory partners (e.g. Corporate Compliance, Privacy Program, etc). Prepare and submit regulatory agency applications, reports, or correspondence ensuring compliance with applicable laws and regulations. Lead the agency review and response to fast-tracked discharge appeals, insurance audits, and CMS Contractor audits.
• Quality Assurance: Conduct regular audits, assessments, and performance evaluations to identify areas for improvement and monitor compliance with CMS Conditions of Participation.
• Healthcare Accreditation: Coordinate and facilitate accreditation activities, such as accreditation surveys, readiness assessments, and corrective action plans. Prepare documentation and evidence for accreditation surveys and ensure compliance with accreditation standards.
• Policy and Procedure Development: Develop and maintain the organization’s policy and procedure library. Ensure that policies are up-to-date, comprehensive, and aligned with regulatory requirements and best practices.
• Risk Management: Identify and assess risks to patient safety, data security, and organizational integrity. Develop risk mitigation strategies and corrective action plans to address identified risks and prevent adverse events or compliance violations.
• Training and Education: Provide training and education to staff on regulatory requirements and compliance standards. Collaborate with departmental leaders to develop and deliver training programs that promote a culture of quality and compliance.
• Data Analysis and Reporting: Collect, analyze, and interpret data related to compliance measures. Prepare reports, dashboards, and presentations to communicate findings and trends to leadership and stakeholders.
• Investigations and Root Cause Analysis: Investigate incidents, complaints, and adverse events to determine root causes and contributing factors. Implement corrective actions and preventive measures to address identified issues and prevent recurrence.
• Performs other regulatory compliance duties, as assigned.

Desired Attributes:
• Master’s degree preferred
• Regulatory audit/survey experience in a healthcare setting
• Experience with metrics and reporting
• RN or another clinical license/certification strongly preferred
• Knowledge/understanding of laws and regulations governed by NYS and CMS

Minimum Qualifications:
• Bachelor's degree
• Minimum of 1 year experience in one or more of the following: Home Health Care OR Clinical Compliance OR Health Care Administration

Required Licensure/Certification:
NA

PHYSICAL REQUIREMENTS: S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

PAY RANGE: $70,000.00 - $95,000.00

The listed base pay range is a good faith representation of current potential base pay for successful applicants. It may be modified in the future. Pay is determined by factors including experience, clinical licensure date, relevant qualifications, specialty, internal equity, location, and contracts.