Department : Compliance & Quality Assurance
Reports To : Leadership Team
Location : Primarily Remote (Must Reside in North Carolina) – Occasional Office Work Required
Hours : 20 Hours per Week
Compensation : $18–$20 per hour (Based on Experience)
Position Summary :
The Compliance & Quality Coordinator is responsible for ensuring that TSG Behavioral Health & Community Services remains in full compliance with Medicaid regulations, MCO guidelines, service definitions, and documentation standards. This role monitors service utilization, ensures service authorizations are properly managed, conducts final reviews for new client and employee files, and ensures clinical documentation meets required standards.
The coordinator is the final reviewer for compliance-related documentation and works closely with supervisors and office staff to develop and implement corrective action plans when issues arise. Additionally, this role is responsible for conducting screening interviews for all new employees to ensure they meet agency standards and regulatory requirements.
This is a part-time (20 hours / week) role , primarily remote , but requires occasional office visits for compliance reviews, audits, interviews, or leadership-requested projects.
Key Responsibilities :
Compliance Oversight & Final Documentation Review
- Serve as the final reviewer for all new client and employee files , ensuring all required documentation is complete, accurate, and compliant.
- Verify that CCAs (Comprehensive Clinical Assessments), treatment plans, and clinical documentation meet Medicaid, MCO, and agency standards before approval.
- Ensure all services strictly follow service definitions and payer regulations before approval.
- Work with supervisors and office staff to implement corrective action plans when compliance issues are identified.
Service Utilization & Authorization Compliance
Monitor service hours used to ensure they align with client authorizations and Medicaid billing rules.Ensure all authorization forms are completed, up to date, and properly documented before service provision.Track service utilization to prevent overuse or underuse of authorized hours and flag discrepancies.Post-Payment Reviews & Audit Management
Manage all payer-initiated audits & post-payment review requests , ensuring accurate and timely documentation submission.Perform internal compliance audits of client files, billing records, and service documentation to proactively identify risks.Work closely with the billing and leadership teams to prevent recoupments, claim denials, or compliance violations .Employee Hiring, Screening & Compliance Training
Conduct initial screening interviews for all new employee candidates to ensure they meet agency and Medicaid compliance standards.Verify credentials, experience, and regulatory compliance before recommending candidates for final interviews.Ensure all new employees understand service definitions, documentation expectations, and compliance policies .Monitor and track completion of required training programs for new and existing employees.Corrective Action & Compliance Enforcement
Work directly with supervisors and office staff to implement corrective action plans when compliance violations occur.Provide ongoing training and guidance to staff on compliance requirements, proper documentation, and service definitions.Maintain records of compliance errors, corrective actions, and process improvements to support quality control efforts.Reporting & Compliance Monitoring
Generate weekly and monthly compliance reports for leadership, outlining compliance risks, corrective actions, and service utilization trends.Ensure strict adherence to service definitions , Medicaid guidelines, and agency policies across all programs.Identify potential compliance risks and recommend proactive solutions before they escalate.Minimum Qualifications :
Education :
Required : Associate's degree in Healthcare Administration, Social Work, Behavioral Health, Public Health, Business Administration, or a related field .Preferred : Bachelor's degree in Healthcare Administration, Social Work, Behavioral Health, or a related field .Experience :
Required : At least 2 years of experience in compliance, auditing, Medicaid billing, behavioral health documentation, or service coordination .Preferred : Experience working with Medicaid service authorizations, MCO policies, and clinical documentation standards .Preferred : Experience in hiring, screening, and interviewing candidates for behavioral health or healthcare roles.Technical Skills :
Experience with EHR systems (e.g., SimplePractice, TherapyNotes, or similar compliance tracking tools) .Strong understanding of Medicaid, MCO, and behavioral health service definitions (training provided as needed).Proficiency in Microsoft Office (Word, Excel) and compliance tracking software .Analytical & Communication Skills :
Ability to review documents for accuracy and compliance errors with strong attention to detail.Effective written and verbal communication skills for staff training, documentation reviews, and corrective action implementation .Ability to work with supervisors and leadership to ensure compliance and address issues proactively.Work Schedule & Location :
Remote-first role , but must reside in North Carolina and be available for occasional office visits as required.Flexible schedule (20 hours per week) with availability for audits, training, and compliance reviews.Occasional travel for on-site audits, interviews, and staff training sessions as needed.Why Join TSG Behavioral Health & Community Services?
Flexible part-time schedule with remote work opportunities.Key role in compliance, service monitoring, and staff hiring.Opportunity for career growth into a larger compliance or management role as the agency expands.Compensation :
18–$20 per hour (Based on experience).No benefits provided at this time, but potential for increased hours or pay based on performance .
Salary : $18 - $20
