Quality and Compliance Specialist

Description

POSITION SUMMARY 

The Quality and Compliance Specialist performs independent internal quality reviews and compliance audit assignments under the guidance of the Quality and Compliance department. This position is responsible for drafting detailed reports of reviews and audit findings, and present findings to management and taking an active role in the overall quality review compliance audit program, recommending changes for improvement or efficiencies.

Demonstrates the ability to identify and research accounting, auditing, and internal control issues during reviews and audits and propose solutions supported by sound analysis. This position is a strong advocate for the people we support and is responsible for the understanding and compliance of all OPWDD, DOH, OCFS, SED, Medicaid and OMIG policies and regulations. The Quality and Compliance Specialist maintains knowledge of required incident reporting and subsequent investigation and follow-up required to meet all regulations of OPWDD and the Justice Center. 

ESSENTIAL RESPONSIBILITIES 

Role responsibilities include but are not limited to the following: 

• Work with the Quality & Compliance department to establish and adhere to the annual quality review and compliance audit work plans. 
• Revise quality review and compliance audit tools to meet the regulatory requirements and conduct quality reviews and compliance audits.  
• Perform assigned quality reviews and compliance audits as needed or assigned through sound auditing practices, including proper audit documentation. 
• Draft quality and compliance reports for review by the quality and compliance department to identify weaknesses in controls, procedures, or operations.  
• Provide recommendations for improvement in systems and processes to ensure quality assurance and quality improvement efforts.  
• Provide training to staff as needed to support program operations, corrective actions, and ensure quality assurance.  
• Ensure corrective action plans are acceptable to correct issues identified from an immediate, systemic, and on-going monitoring perspective.  
• Follow up on issued findings including performing substantive testing to validate issue has been corrected.  
• Ensure compliance with all pertinent government and agency regulations and operating standards.   
• Assist in preparation of quarterly Board Quality & Compliance Committee documents.  
• Attend internal Quality & Compliance Committee meetings.  
• Responds to periodic internal and external program reviews related to reactive and proactive compliance issues.  
• Work collaboratively with leadership and program teams to support document retention initiatives.  
• Research and stay apprised of all pertinent regulations of respective oversight entities to include but not limited to OPWDD, DOH, SED, OMIG. 
• Perform compliance investigations as assigned.\ 
• Attend training to keep up on knowledge of compliance (OMIG) and OPWDD (DQI).  
• Attend training related to incident reporting and investigations provided by but not limited to the Incident Management Unit, OPWDD, and the Justice Center to adhere to all regulations. 
• Maintain knowledge of 624/625 incidents and perform investigations as assigned, including necessary follow up and documentation. 
• Actively participate in Kelberman’s quality and compliance efforts.  
• Maintain and regularly compile data and documentation to be reviewed by supervisor as required.  
• Contribute to a positive work environment through collaborative team-work and positive communication in alignment with Kelberman’s culture, values, and mission.  
• Adhere to mandatory reporting requirements and HIPAA laws. 

JOB REQUIREMENTS  

• High School Diploma or Equivalent. 
• An enhanced understanding of OMIG compliance programs and GAAP accounting standards is preferred.  
• Experience with OPWDD, SED, Article 16 billing, and OMIG audits preferred. 
• Previous internal audit or compliance experience preferred. 
• Proficient ability to analyze a complex set of data and extract critical information to analyze potential threats of exposure to the organization.  
• Excellent written and verbal communication skills. 
• Excellent organization and time management skills.  
• Maintain professional boundaries and confidentiality.  
• Travel between Kelberman sites is required. 
•  Must have a valid NYS Driver’s License and require reliable transportation.