Compliance Coordinator

Compliance Coordinator

The Compliance Coordinator provides essential operational, administrative, and project-based support to the Director of Compliance & Quality Improvement. This position assists in ensuring that all agency programs including PRTF, PCC, and community-based services maintain adherence to regulatory requirements, accreditation standards, risk management practices, and quality improvement initiatives.

The role is responsible for helping implement new procedures, tracking compliance activities, coordinating data collection, assisting with audits, and supporting day-to-day departmental operations across compliance, quality, risk management, medical records, and privacy functions.

Essential Job Functions

• Assist in implementing and maintaining the organization's Compliance Program, ensuring alignment with state licensing rules, CMS requirements, and Medicaid managed care contract standards (MCO requirements follow CMS's credentialing and oversight regulations).
• Conduct routine compliance monitoring activities, including:
• Documentation audits
• Billing reviews
• Medicaid and commercial payer compliance checks
• Policy adherence assessments
• Track and follow up on compliance findings, corrective action plans, and deadlines.
• Support investigations of reported compliance concerns, privacy events, or regulatory inquiries.
• Maintain readiness for all surveys and audits, including:
• State licensing (PRTF, PCC, Outpatient, CMHC-related rules)
• Medicaid and MCO audits
• JCAHO requirements
• Maintain documentation and evidence needed to demonstrate compliance with:
• Staffing ratios
• Treatment planning timelines
• Service authorization rules
• Trauma-informed care standards
• PCC Federal Family First requirements
• Support the Director during onsite or virtual audits, and track compliance.
• Assist with the development, review, and revision of organizational policies and procedures across all programs.
• Monitor federal and state regulatory changes (Medicaid rules, CMS changes affecting MCO obligations, behavioral health statutes) and ensure policies are updated accordingly.
• Maintain organized policy manuals and communicate changes to staff.
• Track staff licensure and certification requirements.
• Support organizational compliance with state mandates preventing the use of excluded providers (federal law prohibits MCOs from using OIG-excluded providers).
• Maintain records for background checks, OIG checks, TB/physical records, CPR certifications, and training compliance.
• Monitor compliance with required time frames for incident documentation and reporting.
• Assist Director with developing and delivering compliance and quality-related training such as:
• Documentation standards
• HIPAA privacy
• Mandatory reporting
• Compliance Code of Conduct
• Incident reporting
• Trauma-informed care monitoring
• Track staff completion of required training modules.
• Maintain documentation for PCC requirements:
• 30-day assessment
• Family involvement documentation
• Discharge planning
• Trauma-informed care practices
• Support audits related to PCC federal requirements.
• Coordinate Departmental Committee meetings, prepare agendas, record minutes, track action items.
• Maintain organized systems for evidence storage (policies, audits, dashboards, corrective plans).
• Provide administrative and analytic support to the Director of Compliance & QI as needed.

Pay: $22.00/hour

Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. This position is in office and not offered remote.

Education and Experience:

• Bachelor's degree in behavioral health, Social Work, Public Health, Healthcare Administration, Quality Management or related field with 2+ years of experience in compliance, quality improvement, credentialing, auding, healthcare operations, or related field within:
• Behavioral Health
• Residential treatment (PRTF/PCC)
• Outpatient/ Community based mental health
• Medicaid or MCO related settings
• Experience supporting regulatory, accreditation, or Medicaid compliance programs.
• Experience with quality improvement methodologies, performance metrics and data tracking.
• Working knowledge of:
• Medicaid and Medicaid Managed Care contract requirements
• CMS requirements for credentialing, provider oversight, and selection (per 42 CFR 438.214)
• Behavioral health licensing rules (PRTF, PCC, outpatient/community services)
• Incident reporting requirements and timelines
• Documentation, billing, and service delivery standards for behavioral health
• Understanding of Medicaid rules requiring clinicians to be properly enrolled and credentialed with the MCO(s) of the beneficiaries they serve.
• Skilled with electronic health records (EHR), compliance software, Excel, and data systems.
• Ability to maintain organized records, logs, dashboards, and audit trails.
• Strong understanding of CAQH, MPPA, and credentialing workflows is a plus.
• Excellent professional writing, documentation, and inter departmental communication abilities.
• Ability to maintain confidentiality and handle sensitive information.
• Strong attention to detail and ability to manage multiple deadlines.
• Professionalism when interacting with auditors, surveyors, MCO representatives, and leadership.
• High integrity and strong ethical judgment.
• Commitment to organizational compliance and continuous quality improvement.
• Ability to work independently while supporting leadership priorities.
• Problem solving mentality with ability to identify trends and recommend corrective actions.