$70, 000 - 80, 000 /Yr.
Schedule: Monday - Friday; 8: 00 am - 4: 30 pm
Location: Rogers Park
Hybrid Schedule: 3 days in-office; 2 days remote

Compliance is the shield that protects Trilogy staff and clients as we walk the road to Recovery together. The Compliance Specialist is responsible for project implementation duties for compliance related projects. This staff will provide support during accreditation survey preparation and follow-up activity and will be the go-to staff deployed to address compliance-related issues with clinical teams. This staff will serve as an investigator/coordinator for external and mandated reports, including to OIG. This specialist will manage the client feedback program, including investigations of complaints and grievances, and will conduct education and training for compliance-related issues including ethical behavior and code of conduct.

The Compliance Specialist is also responsible for monitoring and improving clinical record compliance in accordance with federal, state, local, certifying, and licensing guidelines. They will execute internal audits, present trending and summary reports regarding their findings, and make recommendations regarding improvements to processes or results. The Compliance Specialist must demonstrate an aptitude for data management and information systems, and a well-rounded clinical knowledge base.

Responsibilities

Quality Improvement

• Deploy to individual teams/sites as needed to conduct targeted investigations, ensure follow-up on compliance-related tasks, or to serve as a subject matter expert on compliance issues. Create back-and-forth communication about high-risk processes and improvement opportunities. Help the Director maintain a living inventory of compliance risks.
• Serve as the Director’s primary partner in the preparation, execution, and follow-up for accreditation and certification surveys/audits. Keep on top of new standards and regulations, prioritizing them by risk to the company.
• Manage the client feedback program under supervision of the Director. Conduct initial investigations into client complaints/grievances and help leadership staff navigate the complaint escalation process within our PHP reporting software.
• Serve as a liaison with OIG and mandated reporting agencies. Coordinate investigations, interviews, and document submissions under supervision of Director. Assist Director in compliance investigations and follow-up activity for other regulators.
• Participate in projects to improve compliance with policies, procedures, regulations, etc. Help staff to close the gaps that you identify. Practice improvement science and change management skills.
• Review client health records and clinical documentation (utilization reviews, clinical note reviews, residential reviews, SUPR reviews, employment service reviews, etc.) pertaining to state regulations, including assessing the quality of clinical documentation, level of care, and overall level of services; i.e. Rule 140, Rule 132, and Rule 2060 through internal quarterly audits. Collect and analyze data to make recommended process improvements and identify training needs.
• Compile statistical data and produce narrative reports summarizing compliance findings. Assist the clinical leadership team in identifying trends in documentation. Provide meaningful feedback about quality improvement activity and possibilities to all stakeholders.
• Coordinate with and educate employees regarding documenting medical necessity for services being requested for authorization, by partnering with clinicians to ensure documentation is timely and supports the services identified.
• Acts as a resource to other departments regarding utilization management matters, coverage guidelines, and assisting as needed with clinical or claims issues.
• Support the Quality Team with completion of medication audits, mortality reviews, visits to clinical or administrative teams, site visits, targeted investigations, change management tasks, and internal communication.
• Participate in meetings, committees, and work groups as needed.
• Perform other related duties and/or projects as assigned.

Qualifications

• Bachelor’s degree in Social Work, Psychology, Counseling, or health related field required, Master’s degree preferred.
• Licensed Clinical Professional Counselor or Licensed Clinical Social Worker in Illinois preferred.
• Minimum two years’ experience in a healthcare, social services, or non-profit setting, preferably in a compliance role
• Ability to spend minimum 2 days per week on site, with availability for more on site days as work duties require.
• Experience in reviewing health care services for medical necessity in a clinical setting or in a utilization management role or similar activities preferred.
• Knowledge and understanding of medical necessity, Rules 132, 140, 115, 2060 preferred
• Knowledge of change management skills is preferred
• Excellent interpersonal, organizational and oral/written communication skills, and ability to engage with stakeholders at all levels.
• Superior ability to collaborate and interact with other programs/departments
• Experience with developing workflows and/or processes highly preferred
• Maintenance of confidentiality and adherence to HIPAA regulations
• Detail oriented and ability to complete projects with strict deadlines
• Advanced computer skills in Microsoft Office applications, and ability to learn new computer systems

Benefits:

• FREE Virtual Primary Care, Urgent Care, and Mental Health Counseling for ALL Employees
• PAID Maternity/Paternity leave
• Medical Insurance (BCBS of IL)
• Dental Insurance
• Vision Insurance
• Life Insurance
• Long-Term & Short-Term Disability
• Pet Insurance
• FSA (Health, Dependent Care, Transit)
• Telemedicine
• EAP
• 403(b) Retirement Plan with Employer Match

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.