Clinical Compliance Consultant

AQORD

Blue Bell, PA

Full Time

Clinical Compliance Consultant

Join a team of dynamic healthcare professionals providing compliance and privacy services in the Life Plan/CCRC and post-acute environment. Great opportunity for professional growth and development.

The Clinical Compliance Specialist performs on-site compliance and regulatory reviews and audits for a diverse group of organizations in multiple states.


The Clinical Compliance Specialist will

• Conduct reviews and audits that encompass a variety of subject matter, including those surveyed under State and/or Federal regulations, or laws with a focus on clinical services, including professional standards of care.
• Assist with ensuring compliance with regulatory requirements associated with the Centers for Medicare and Medicaid Services (CMS), Office of Inspector General (OIG), Office of Civil Rights (OCR), the Health Insurance Portability and Accountability Act (HIPAA), and state regulatory authorities.
• Review medical records, billing, and associated supporting records to validate accurate, comprehensive documentation that substantiates the medical necessity, quality of care, utilization of therapy services, and coding of claims associated with Medicare and/or Medicaid reimbursement.
• Assist with implementing recommendations or changes as necessary, including education and training, developing clinical and operational policies and procedures, and guiding implementation of the organizations, systems or services that enhance organization compliance.

Essential Duties and Responsibilities

• Perform compliance and regulatory audits for organizations in areas surveyed by State and federal regulations and laws.
• Assist with ensuring compliance with Medicare, Medicaid, state regulatory guidelines, billing rules, and HIPAA regulations.
• Assist in monitoring the activities and regulations of CMS and various state Departments of Health.
• Contribute to the development and implementation of programmatic changes and development and provision of participant support through email and phone contact.
• Travel to off-site locations. Overnight travel is required.

Desired Skills & Experience

• Minimum of 7 years’ experience in the Long-Term Care, Post-Acute/Healthcare industry.
• Bachelor’s Degree/License: Nursing, Physical Therapy, Occupational Therapy, or Speech Therapy
• Working knowledge of Medicare and Medicaid Coding and Billing, and Federal and State regulations in the post-acute environment.
• The ability to be flexible and adapt to a changing regulatory environment.
• Operational experience in the CCRC or other post-acute care environment.
• Strong written and verbal communication skills.
• Ability to travel and work independently.
• This program covers 17 states and requires extensive travel.

About AQORD Compliance Collaborative

The AQORD Compliance Collaborative knows that every organization’s journey to compliance is different. Whether you’re building a program from the ground up or strengthening what already exists, keeping pace with evolving regulations can feel overwhelming. Our multidisciplinary team walks alongside you, assessing your needs, tailoring solutions, and helping you build and sustain a culture of compliance that supports your mission and empowers your organization.

AQORD supports values-aligned health and human services organizations through connection, collaboration, and shared commitment. We administer a collaborative program of compliance services called the AQORD Compliance Collaborative.

Interested parties should send their cover letter, resume, and salary requirements to [email protected] .