What are the responsibilities and job description for the Compliance Manager position at Community Options, Inc.?
Community Options, Inc. is a national non-profit agency providing services to individuals with disabilities in 12 states.
We are now hiring a skilled Compliance Manager in Pittsburgh, PA. The Compliance Manager is responsible for the supervision of the compliance specialists ensuring internal monitoring and audits to evaluate the COI’s compliance with requirements and overall effectiveness of the Corporate Compliance Program. This includes the monitoring and auditing of billing records using the federal and state regulations meeting Center for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (HHS), and the Office of Inspector General (OIG) guidelines to identify potential overpayments. This role requires a unique blend of compliance expertise and analytical skills to monitor, assess, and optimize compliance processes using data-driven insights.
Responsibilities
- Oversee auditing and monitoring schedules and activities for Compliance Specialists
- Maintain current knowledge of internal audit techniques and best practices
- Review internal and external audits of claim reviews ensuring appropriate documentation
- Conduct internal audits and follow-up validations of internal processes
- Identify areas of risk and provide recommendations for mitigation
- Complete audit reports by documenting the audit plan, risks, tests, findings, recommendations, executive summary, and validation
- Conduct comprehensive record reviews
- Investigate reports of non-compliance and provide comprehensive reports with recommendations
- Submit regular reports and communicate findings to the Director of Data Analytics
- Recommend any necessary changes in current policy and procedures
- Maintain a master file of all audits
Minimum Requirements
- Bachelor’s degree in healthcare administration, accounting, or a related field and three years of relevant experience
- Certification as CHC, CHRC, or CHPC preferred
- Valid driver’s license with a satisfactory driving record
- Experience with billing practices and guidelines
- Understanding of CMS, HHS, and OIG regulations
- Ability to present facts and recommendations effectively in oral and written form
- Independent judgment is required to plan, prioritize, and organize a diversified workload
- Ability to demonstrate poise, tact, and diplomacy
- Excellent presentation and verbal skills
- Analyze large data sets from multiple sources to identify compliance trends, gaps, and areas of improvement.
- Strong proficiency in Microsoft Office, particularly Excel
- Proficiency in data analysis tools and business intelligence platforms (e.g., Tableau, Power BI).
- Knowledge and understanding of local regulatory agency operations
- Employment is contingent upon successful completion of checks of criminal background, central registry, child abuse registry, and drug testing
Why Community Options?
- Competitive Insurance Benefits (Medical, Dental, Vision)
- Paid Holidays—Including a Birthday Holiday
- Generous PTO
- Employee Incentive & Discount Programs
- 403b Retirement Plan
- Incredible career growth opportunities
- University partnerships that include tuition reduction
Community Options is an Equal Opportunity Employer M/F/D/V
#IND-NA
Job Type: Full-time
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Experience:
- Understanding of CMS, HHS, and OIG regulations: 1 year (Required)
Work Location: On the road
