Compliance Coordinator at THRIVE Wellness and Recovery Inc

City of Watertown, New York, United States -

Full Time

Start Date

Immediate

Expiry Date

21 May, 26

Salary

23.0

Posted On

20 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Billing Regulations Compliance, Medicaid Billing Auditing, Auditing Tool Development, Payer Regulations Interpretation, Overpayment Refunding, Confidentiality Adherence, HIPAA Compliance, 42CFR Compliance, Internal Collaboration, External Agency Audits, Quality Assurance, Staff Training

Industry

Mental Health Care

Description

Description Schedule Monday-Friday: 8am-4:30pm SUMMARY The Compliance Coordinator will play a critical role in ensuring compliance with billing regulations and maintaining the integrity of billing practices across all applicable programs. The Compliance Coordinator is responsible for interpreting regulations, conducting routine audits for Medicaid billing and developing and maintaining auditing tools that align with payer regulations. The Compliance Coordinator will implement systematic activities to ensure compliant billing, and support refunding of overpayments to governing authorities. Adherence to confidentiality standards, including 42CFR and HIPAA, is a key responsibility as is strong collaboration with internal teams, external agencies and the ability to manage multiple compliance-related tasks effectively. ESSENTIAL DUTIES AND RESPONSIBILITIES Interpret regulations in order to apply to THRIVE Wellness and Recovery Inc. standards. Perform routine audits of Medicaid billing. Develop and maintain auditing tools consistent with payer regulations. Implement planned and systematic activities that will ensure compliant billing in assigned programs. Attend team meetings as needed. Educate and or train staff on details of payor billing requirement as requested. Evaluate and monitor billing procedures to include practices related to the refunding of over payments to the appropriate governing authority or agency. Review/investigate records in order to confirm quality of care, contact and accurate billing practices. Assist as needed with audits carried out by external agencies to include but not limited to: Medicaid, OASAS, OMH, CARF, Managed Care Plans. Work collaboratively with OMIG in the event of an audit. Participates in additional agency committees as assigned. Promote, monitor and adhere to high level of confidentiality of 42CFR, HIPPA in record reviews. Conduct orientation or training on various topics for employees as needed. Other related duties as assigned. Management has the right to add or change the duties of this position at any time. Requirements QUALIFICATIONS 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 accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION and/or EXPERIENCE Required: Associate’s degree and Four years of relevant experience in a Human Services Program. Bachelor’s degree and two years of relevant experience in Human Services OR Preferred: Qualified Mental Health Specialist (QMHS). Experience in quality assurance.

Responsibilities

The Compliance Coordinator ensures adherence to billing regulations by interpreting rules, conducting routine Medicaid billing audits, and developing necessary auditing tools. This role also involves implementing systematic activities for compliant billing and supporting the refunding process for overpayments.