Overview

APPLY DIRECTLY BY VISITING: (link removed)The Clinical Compliance Specialist serves as the internal expert in behavioral health regulatory standards and the lead for CHRIS180s compliance-based Continuous Quality Improvement (CQI) initiatives. Primary focus areas include ensuring compliance with DBHDD requirements, Medicaid regulations, accreditation standards, private insurance guidelines, and funder clinical expectations.The Clinical Compliance Specialist focuses on improving clinical quality, reducing audit risk, strengthening documentation practices, and driving sustainable operational improvements through data analysis and cross-functional collaboration.Role and ResponsibilitiesThe primary duties include but are not limited to the following:Regulatory Leadership & Expertise: Ensure compliance with all applicable federal, state, and local regulations, accreditation standards, licensing requirements, and organizational policies. Oversee operational readiness for audits, accreditation reviews, licensing inspections, and regulatory surveys. Monitor compliance metrics and implement corrective action plans as needed. Maintain current knowledge of regulatory changes impacting behavioral healthcare operations with a focus on DBHDD, Medicaid, and commercial insurance. Actively monitor regulatory updates and communicate changes throughout CHRIS180.and determine operational impact. Serve as the primary internal resource for interpretation of behavioral health regulations. Coordinate implementation of new regulatory requirements across departments. Maintain payer requirement reference materials. Ensure policies remain current based on DBHDD updates, Medicaid policy changes, audit findings and results, and commercial insurance guidelines. Update policies to ensure alignment and promote operational efficiency and clinical best practices. Partner with Revenue Cyle, Billing, Clinical Services, Operations, and Utilization Management to ensure compliance. Develop educational resources and deliver trainings as regulations evolve. Coordinate with Utilization Management to support their insurance paneling & credentialing efforts.Performance Monitoring & Continuous Quality Improvement: Produce compliance dashboards for executive leadership on a monthly and quarterly basis with actionable recommendations. Facilitate compliance-based Quality Improvement meetings. Develop and monitor quality metrics for documentation compliance, authorization timeliness, treatment plan compliance, assessment completion rates, service delivery timeliness, audit findings, corrective action completion, and clinical documentation trends. Analyze trends involving audit outcomes, documentation deficiencies, authorization denials, claim trends, compliance indicators, and clinical quality measures.Investigations & Risk Management: Conduct internal investigations involving reported fraud, waste, or abuse allegations. Conduct regular chart audits to identify and correct compliance risks. Monitor adherence to industry standards, including insurance payer requirements, Medicaid documentation guidelines, and legal mandates. Coordinate with Compliance Manager, Clinical leadership and Executive Leadership regarding compliance concerns.TOTAL REWARDS at CHRIS 180:Hybrid work schedule based on department/program needsPaid Time Off (PTO)11 paid holidays, including company break from 12/24 - 1/1Competitive 403 (b) benefit defined contribution planHealthcare insurance options (HMO and PPO)Dental and Vision insurance optionsEmployer-paid short-term disabilityEmployer-paid basic life insurance (1x times your salary)Employee Assistance Program (EAP)Flexible Spending Account (FSA)Discounted college tuition for select colleges and universitiesRequirements: Bachelors degree required in Healthcare Administration, Business Management, Psychology, Social Work, Counseling, or a related field. Masters Degree preferred. Clinical experience preferred. Accreditation experience preferred. Minimum of