Quality & Compliance Specialist

Quality & Compliance Specialist

Hybrid Remote • Must be in the Phoenix metro area, AZ

• Quality & Compliance

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Job Type

Full-time

Description

• POSITION SUMMARY The Quality and Compliance Specialist will support the organization’s compliance day-to-day quality and compliance operations, monitor contractual and regulatory requirements, and support continuous improvement efforts across programs and departments.

• The Quality and Compliance Specialist is also responsible for conducting audits, investigations, corrective action planning, reporting, staff support, and compliance tracking activities while promoting a culture of accountability, quality improvement, and operational excellence. This position requires strong analytical, organizational, project management, and leadership skills, as well as the ability to manage multiple priorities in a fast-paced environment.

QUALIFICATIONS

• Bachelor’s degree in public policy, Social Sciences, Business Administration, Healthcare Administration, or related field; or equivalent combination of education and experience

• Minimum of 2 years of experience in quality compliance, auditing, healthcare administration, Medicaid programs, or related field

• Previous experience coordinating audits, compliance reviews, corrective action plans, or regulatory reporting activities

• Knowledge of Medicaid, State, and Federal regulations and contractual compliance requirements

• Strong project management, organizational, analytical, and problem-solving skills

• Ability to manage multiple priorities and deadlines with limited supervision

• Excellent written and verbal communication skills

• Strong attention to detail and ability to maintain confidentiality

• Experience using Microsoft Office applications including Word, Excel, Outlook, and PowerPoint

• Ability to learn and become proficient in all Acumen-specific systems and programs

• Valid driver’s license within state of residence and valid automobile insurance

• PREFERRED QUALIFICATIONS

• Experience conducting Medicaid audits and regulatory reviews

• Experience with quality improvement methodologies and process improvement tools

• Knowledge of HIPAA requirements and healthcare compliance standards

• Experience analyzing data, identifying trends, and presenting findings to leadership

• Experience developing or facilitating staff training programs

• Previous experience in social services, healthcare operations, or managed care environments

Requirements

• ROLE AND ESSENTIAL FUNCTIONS
• Maintain detailed understanding of all current AFA contracts, provider manuals, policies, and applicable State and Federal regulations
• Serve as a subject matter resource regarding contract compliance, program requirements, and quality assurance processes
• Act as a liaison between Program Managers, Executive Directors, Operations teams, and other departments to resolve compliance concerns, contractual issues, audit findings, and operational risks
• Assist with the implementation and oversight of quality compliance programs, systems, and initiatives across the organization
• Coordinate and oversee internal and external audits, Requests for Information (RFI), subpoenas, surveys, and regulatory reviews
• Facilitate cross-department collaboration to compile accurate and timely audit documentation while maintaining compliance with HIPAA and contractual requirements
• Review audit findings, identify trends and risks, and provide recommendations to leadership to support quality improvement initiatives
• Monitor and oversee complaint tracking, investigations, trending analysis, and escalation processes
• Support departments in developing and implementing corrective and preventative action plans to resolve compliance and quality concerns
• Research, analyze, and communicate changes in legislation, regulations, contracts, and program requirements that may impact operations or organizational compliance
• Assist in the development, implementation, and maintenance of policies, procedures, forms, reporting tools, and internal controls to support compliance objectives

Acumen

Salary Description

$55,000 - $65,000

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