Compliance & Regulatory Affairs Specialist

Description

About Dover Health:

Dover Health is a regional hospice and home health care provider devoted to helping every senior and their family thrive through personalized and holistic health.

Position Summary:  

The Compliance & Regulatory Affairs Specialist reporting directly to the Associate General Counsel is responsible for building, managing, and continuously improving Dover Health’s compliance program across its home health, hospice, and palliative care service lines. This role owns all seven elements of an effective compliance program as outlined by the HHS Office of Inspector General’s General Compliance Program Guidance (GCPG), oversees provider, vendor and staff credentialing, leads chart review and audit activities, and ensures ongoing adherence to Medicare and applicable state Medicaid requirements. 

Essential Duties: 

The following duties are normal for this position.  This list is not to be construed as exclusive or all-inclusive.  Other duties may be required and assigned. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.  

• Draft, maintain, and update compliance policies and procedures that reflect current federal and state regulatory requirements across home health, hospice, and palliative care operations. 
• Serve as the designated Compliance Officer; convene and support a Compliance Committee; report regularly to the Associate General Counsel and senior leadership on program status, risks, and corrective actions. 
• Develop and deliver role-specific compliance training for clinical, administrative, and operational staff; track completion and address gaps. 
• Maintain confidential reporting channels (including a hotline or equivalent mechanism); ensure staff can report concerns without fear of retaliation; investigate and resolve compliance reports in a timely manner. 
• Conduct and oversee regular internal audits and monitoring of coding, billing, documentation, and clinical practices; implement risk-based audit schedules; coordinate with external auditors as needed. Maintain and update the compliance risk assessment on at least an annual basis. 
• Collaborate with Human Resources to administer and consistently enforce disciplinary standards for compliance violations; advise leadership on corrective action consistent with applicable law and policy. 
• Investigate potential violations promptly; design and implement corrective action plans (CAPs); coordinate voluntary disclosure when appropriate; track CAP completion and effectiveness. 
• In partnership with agency leadership, ensures organizational compliance with HIPAA and applicable federal and state privacy and security requirements.  
• Ensure ongoing compliance with Medicare Conditions of Participation (CoPs) for home health and hospice. 
• Monitor regulatory changes from CMS and ensure timely policy and operational updates. 
• Oversee Illinois Medicaid and Missouri Medicaid enrollment and compliance requirements specific to home health and hospice services. 
• Support preparation for and response to Medicare Administrative Contractor (MAC) audits, RAC audits, and state survey activity. 
• Oversee end-to-end state licensing and renewals for all agencies.  
• Maintain current enrollment and credentialing files; manage primary source verification processes. 
• Monitor OIG exclusion lists and applicable state exclusion databases for all employees, contractors, and vendors on a regular basis for Illinois and Missouri. 
• Manage registration and submission of employment credentials for the Illinois Department of Public Health and the Missouri Family Care Safety Registry.  
• Lead and conduct prospective, concurrent, and retrospective chart reviews for home health, hospice, and palliative care encounters. 
• Evaluate documentation for completeness, accuracy, and compliance with Medicare and Medicaid coverage requirements. 
• Analyze audit findings; prepare written reports for the Associate General Counsel, Compliance Committee, and senior leadership. 
• Develop and track corrective action plans arising from audit findings; measure and report on outcomes. 
• Monitor applicable OIG Work Plan items, CMS transmittals, and other regulatory guidance for relevance to Dover Health operations. 
• Coordinate with external legal counsel on compliance matters as directed by the Associate General Counsel. 
• Serve as a resource to operations, clinical, and billing teams on day-to-day compliance questions. 
• Other duties as assigned. 

Qualifications, Education and/or Experience:  

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and abilities required. 

• Minimum five (5) – seven (7) years of hands-on compliance experience in home health, hospice, or palliative care settings, with demonstrated knowledge of Medicare CoPs and home health/hospice billing rules. 
• Strong working knowledge of OIG’s seven elements of an effective compliance program. 
• Direct experience with chart review, internal audits, and documentation improvement in a home health or hospice environment. 
• Familiarity with Illinois Medicaid and Missouri Medicaid requirements applicable to home health and hospice. 
• Demonstrated ability to investigate compliance concerns, prepare written findings, and implement corrective action. 
• Experience with federal healthcare fraud and abuse laws (e.g., Anti-Kickback Statute, Stark Law, False Claims Act).  
• Excellent written and verbal communication skills; ability to translate regulatory requirements into plain-language guidance for clinical and non-clinical staff. 
• Health law paralegal background (e.g., experience supporting healthcare regulatory or compliance counsel) or a Registered Nurse (RN) license preferred. 
• Certified in Healthcare Compliance (CHC) or Certified Compliance and Ethics Professional (CCEP), or ability and commitment to obtain within 18 months of hire is preferred. 
• Experience navigating a variety of electronic health record systems is preferred.  
• Working knowledge of CHAP or Joint Commission accreditation standards is preferred. 
• Experience with SNF or other post-acute care compliance is preferred. 

Working Conditions:  

As part of Dover Health’s commitment to providing outstanding care and support, the company ensures that staff work under conditions that prioritize safety, collaboration, and professional growth. 

• This position is based at the corporate office with regular daily presence expected. 
• The role is primarily sedentary and desk-based, involving extended periods of computer work, document review, and telephone communication. 
• Occasional travel (up to 20%) to agency locations and external meetings may be required. 
• This position requires the ability to manage multiple concurrent projects under deadline and to exercise strong time management and organizational skills. 
• Employees are required to remain current on all training, ongoing education initiatives, and self-improvement opportunities to maintain and enhance compliance expertise. 
• This role involves actively participating in staff activities that foster teamwork, unity, and morale as a collaborative team player. 

We are an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, we will provide reasonable accommodations to qualified individuals with disabilities and encourages prospective employees and incumbents to discuss potential accommodations with the employer.

Dover Health considers the health and safety of its patients, family members, and team members as its highest priorities. All offers of employment are contingent upon the successful completion of a background check and drug screening, participation in required health assessments (such as TB testing or physical evaluations), and the use of designated personal protective equipment (PPE) as required by company policy and applicable law.