Sr. Compliance Specialist

About the Role

Our Compliance Team is looking for a Sr. Compliance Specialist who can support the compliance department in reviewing legal documents, conducting and responding to internal/external audits, and investigating Fraud, Waste & Abuse (FWA) claims. The Compliance Specialist role will encompass a wide range of responsibilities that will aid the department in maintaining regulatory requirements.

Every Day You Will

• Conduct and respond to internal and external audits for all jurisdictions.

• Assist with conflict reporting and collaborate with our finance department to resolve conflicts.

• Manage subpoena of medical records and general record requests.

• Investigate fraud, waste & abuse claims.

• Make suggestions on next steps of FWA claims.

• Be a resource for escalated concerns for all active states.

• Perform quality assurance review.

• Handle all other compliance duties as assigned.

Ideal Candidate Will Possess

• Bachelor’s degree and a minimum of 3 years of experience in the healthcare industry, or Associate degree and a minimum of 5 years of experience in the healthcare industry.

• Extensive knowledge of Medicaid regulations.

• Experience with exclusion screening and background checks.

• Extensive knowledge of billing and coding preferred.

Nice-to-Haves

• Ability to exercise good judgment in using knowledge of best practices, regulations, and business processes.

• Ability to work with limited supervision on complex matters; self-starter and takes initiative.

• Demonstrated ability to be detail-oriented and thorough.

• Reliable and detail-oriented.

• Adept at multi-tasking.

• Prior experience with internal and external audits.

Why Work at FreedomCare?

We are here for you and committed to providing a best-in-class employee experience. We offer competitive compensation, medical benefits, retirement plans, wellness programs, fun company events, and ongoing learning opportunities to grow your career.

This is a place where your voice matters, where we build great relationships, and your work has meaning and a tangible positive impact on others!

At FreedomCare, we celebrate diversity and are committed to creating an inclusive environment for all employees. We are an Equal Opportunity Employer and do not discriminate based upon race, religion, color, national origin, ancestry, age, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, status as a protected veteran, status as an individual with a disability, citizenship or immigration status, or other applicable legally protected characteristics.

Compensation

At FreedomCare, base pay is one part of our total compensation package and is determined within a range. This provides our employees with the opportunity to professionally grow and develop within a role.