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The primary responsibility of the Compliance Specialist is to review clinical medical records and claims for accuracy of services related to home health care. The Compliance Specialist maintains a comprehensive understanding of ethical principles and independence in their work, professional conduct, duty, and responsibilities. The Compliance Specialist is obligated to articulate principles, have a working knowledge of the rules and regulations as they pertain to all aspects of home healthcare, and observe/ensure the highest level of professional standards, quality care, and legal aspects.

Essential Duties and Responsibilities:

• Reviews clinical medical records and claims for accuracy of services related to clinical standards of practice and care, levels of care, quality indicators, medical necessity, length(s) of stay, billing, and denials

• Makes proposals related to compliance and continuous quality improvement

• Conducts exit conferences and provides timely written feedback

• Works collaboratively with Regional Operations and Site Managers

• Participates in provider educational programs

• Serves as a resource, providing information generated from a sound basis

• Ensures confidentiality of medical information related to HIPAA regulations

• Displays dedication to corporate objectives

• Performs audits as scheduled by the Compliance Leadership team

• Completes work product in an accurate and timely fashion as required by the Compliance Leadership team

• Ensures business travel is consistent with the business objectives of the Compliance Department, and submits all expense reimbursement requests within 30 days of site visit

• Assists with clinical review for claims testing activities

• Assists with clinical review for issues investigation and resolution

• Performs other duties as assigned/necessary

Minimum Requirements:

• Active RN license required

• BSN or other commensurate healthcare degree preferred

• Experience in utilization review, risk management, quality management, documentation specialization, nurse management, compliance, billing, coding, or CFE, LNC, or CPUR certification preferred

• At least five years of clinical experience required, preferably in Home Health

• Demonstrated knowledge of clinical compliance, medical record review and legal aspects of documentation preferred

• Demonstrated knowledge of CPT, ICD 10 codes, DRGs, and APC coding preferred

• Understanding of payer rules and regulations, including Medicare and Medicaid preferred

• Computer proficiency, including programs such as MS Office, Word, Excel, email, and internet research, required

• Travel 50% - 75% of the work time may be required

• Ability to effectively elicit/provide information to and from appropriate individuals (including, but not limited to, supervisors, co-workers, clients) via strong communication skills preferred

• Proficiency in the English language is required

  About Maxim Healthcare Services

Maxim Healthcare Services has been making a difference in the lives of our patients, caregivers, employees and communities for more than 30 years. We offer private duty nursing, skilled nursing, physical rehabilitation, companion care, respite care and behavioral care for individuals with chronic and acute illnesses and disabilities. Our commitment to quality customer service, compassionate patient care, and filling critical healthcare needs makes us a trusted partner wherever care is needed.

Maxim Healthcare Services is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.