Clinical Compliance Specialist
1 week ago
Location: Wake Forest, NC
Schedule: Monday - Friday, 8:00 AM - 5:00 PM (in-office, not remote)
Employment Type: Full-Time, Salaried
About Us
Family Solutions is a community-based behavioral health organization dedicated to delivering high-quality services while maintaining full compliance with state, federal, and accreditation standards. We are seeking a mid-level Clinical Compliance Specialist to join our Wake Forest corporate office. This role ensures ongoing clinical integrity, ethical practice, and regulatory compliance across our multi-state behavioral health operations.
Position Summary
The Clinical Compliance Specialist is responsible for overseeing clinical documentation, quality assurance, and regulatory compliance activities. The position requires at least three (3) years of compliance, auditing, or quality assurance experience in healthcare or behavioral health settings. A clinical license or provisional licensure is strongly preferred, as this role includes medical necessity review and oversight of clinical documentation practices.
The Clinical Compliance Specialist serves as the primary auditor and regulatory liaison for clinical operations, supporting HR, training, and quality improvement initiatives.
The Compliance Specialist at Family Solutions:
- Acts as the primary auditor and regulatory liaison across HR, clinical, and program operations.
- Ensures compliance with employment regulations, personnel standards, and HR policies in addition to clinical audits.
- Prepares for and participates in CARF and state surveys.
- Issues Corrective Action Plans and ensures implementation.
- Represents the agency with regulators, county boards, and external partners.
Clinical Compliance
- Conduct weekly audits of clinical charts, including assessments, treatment plans, progress notes, medication management, and discharge documentation.
- Ensure documentation meets medical necessity, state Medicaid, CARF, and federal standards.
- Participate in external audits, CARF surveys, and state or MCO inspections.
- Oversee corrective action plans and monitor implementation to completion.
- Provide consultation and training on documentation and compliance standards to clinicians and supervisors.
- Respond to medical records requests from clients and external agencies in accordance with HIPAA and organizational protocols.
- Support the development and implementation of the agency's Corporate Compliance Program and risk management initiatives in alignment with the Policy and Procedure Manual.
- Develop and deliver compliance-related training to clinical and administrative staff.
- Collaborate with Clinical Supervisors and Directors to identify trends in documentation deficiencies and develop quality improvement strategies.
- Oversee the Learning Management System (LMS) for compliance and clinical trainings, ensuring annual updates, accurate course tracking, and reporting.
- Support internal investigations of documentation errors or compliance concerns, ensuring timely resolution and documentation.
- Audit licensure, certification, and credentialing records of clinical personnel for accuracy and validity.
- Ensure compliance with HR policies, background checks, mandatory trainings, and continuing education requirements.
- Prepare reports and corrective action plans related to HR or clinical compliance findings.
- Maintain familiarity with state and federal employment laws, Medicaid standards, and CARF accreditation requirements.
- Compile and present monthly and quarterly compliance reports to Clinical Directors, Program Directors, and executive leadership.
- Participate in Compliance and QA&PI Committee meetings, providing updates on audit results, risk areas, and corrective actions.
- Represent Family Solutions in meetings with external regulators, payors, and community stakeholders.
- Maintain strict confidentiality and ensure adherence to HIPAA and ethical standards in all compliance functions.
Required:
- At minimum, a Master's degree in social work, counseling, psychology or related field.
- At least 3 years of experience in compliance, auditing, or quality assurance within a behavioral health or healthcare organization.
- Strong understanding of Medicaid, CARF, and clinical documentation standards.
- Active clinical license (LPC, LCSW, LMFT, LISW, or equivalent) in North Carolina, Ohio, Illinois and/or Texas.
- Experience leading audits or compliance reviews in multi-state behavioral health settings.
- Excellent written and verbal communication skills.
- Strong organizational, analytical, and project management abilities.
- High degree of integrity and confidentiality.
- Proficiency in Microsoft Office Suite, Google Workspace, and EHR systems.
- Valid driver's license and willingness to travel to site offices in Ohio, Illinois, and Texas as needed.
- Competitive salary and benefits package.
- Ongoing professional development and continuing education support.
- A collaborative and mission-driven workplace culture.
- Opportunities for advancement in compliance and leadership.
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