The primary responsibility of the Behavioral Compliance Specialist I is to review behavioral client files and claims for accuracy of services related to behavioral service. The Behavioral Compliance Specialist I maintains a comprehensive understanding of ethical principles and independence in their work, professional conduct, duty, and responsibilities. The Behavioral Compliance Specialist I is obligated to articulate principles, have a working knowledge of the rules and regulations as they pertain to all aspects of all behavioral services and observe/ensure the highest level of professional standards, quality care, and legal aspects.
- Conducts comprehensive reviews of behavioral client files and claims for accuracy of services related to clinical standards of practice and care, levels of care, quality indicators, medical necessity, length(s) of stay, billing, and denials
- Makes proposals related to compliance and continuous quality improvement
- Conducts exit conferences and provides timely written feedback
- Works collaboratively with Regional Operations and site managers
- Participates in provider educational programs
- Serves as a resource for the behavioral service line
- Provides education and training on compliance and clinical standards to staff members
- Ensures confidentiality of medical information related to HIPAA regulations
- Displays dedication to corporate objectives
- Performs audits as scheduled by the Compliance Leadership team
- Assists with clinical review for claims testing activities
- Assists with clinical review for issues investigation and resolution
- Completes work product in an accurate and timely fashion as required by the Compliance Leadership team
- Ensures business travel is consistent with the business objectives of the Compliance Department, and submits all expense reimbursement requests within 30 days of site visit
- Performs other duties as assigned
- Active license or certification in good standing in behavioral field (e.g. Board Certified Behavior Analyst, Licensed Behavior Analyst) when applicable by state
- A minimum of five (5) years of experience in the behavioral field business line setting (e.g. home, community, schools) and at least one year of supervisory experience is required
- Other behavioral/mental health license or certification may be considered if paired with at least 3 years of experience in applied behavior analysis (e.g. Board Certified Assistant Behavior Analyst, Licensed Social Worker, Licensed Marriage and Family Therapist), when allowed by state or program
- Demonstrated knowledge of clinical compliance, behavioral client file review and legal aspects of documentation preferred
- Understanding of payer rules and regulations preferred
- Computer proficiency including Microsoft Office Suite (Word, Excel, Teams, etc.)
- Travel 50% - 75% of the work time may be required
- Ability to effectively elicit/provide information to and from appropriate individuals (including, but not limited to, supervisors, co-workers, clients)
- Proficiency in the English language is required
- Excellent communication skills
Pay Information
$100,000 - $115,000 + bonus $7,000
- Benefit eligibility is dependent on employment status.
**Specific Benefits: Medical/Prescription, Dental, Vision, Health Advocacy (company paid if enrolled Medical), Health Advocate Employee Assistance Program, Health Savings Account, 401(k) + Company Match, Profit Sharing, Short Term Disability, Long Term Disability, Primary Caregiver Leave, Parental Leave, Life and Basic Accidental Death & Dismemberment Insurance, Voluntary Group Life Insurance and Supplemental Accidental Insurance, Hospital Expense Protection Plan, Critical Illness Insurance, Dependent Care Flexible Spending Account, Home and Auto Insurance discounts, Pet Insurance, Transportation Benefits, Educational Assistance Program, College Partnership Program, Legal Benefits, Employee Discount Program, Paid Time Off/Company Holidays.
About Maxim Healthcare Services
Maxim Healthcare Services has been making a difference in the lives of our patients, caregivers, employees and communities for more than 30 years. We offer private duty nursing, skilled nursing, physical rehabilitation, companion care, respite care and behavioral care for individuals with chronic and acute illnesses and disabilities. Our commitment to quality customer service, compassionate patient care, and filling critical healthcare needs makes us a trusted partner wherever care is needed.
Maxim Healthcare Services is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.
