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Compliance Specialist

Job Description


The Compliance Specialist conducts compliance and clinical quality monitoring activities, generates reports, and coordinates and leads performance improvement projects or training activities. This position participates in the preparation and coordination of internal and external reviews and requires knowledge and understanding of Connecticut and Federal regulations, Medicaid and the Joint Commission as utilized in conducting internal reviews to validate Clinic compliance. The Compliance Specialist also attends interdepartmental meetings facilitating collaboration pertaining to educating and implementing compliance requirements and the monitoring of quality of services.



Wheeler Clinic fosters positive change in the lives of individuals and families, as well as in communities. We provide cutting-edge human services that address a diverse range of needs and backgrounds, enhance strengths and provide the supports that encourage recovery from challenges for a satisfying life in the community.



Wheeler Clinic offers access to a comprehensive array of benefits, including:

For Good Health

  • Anthem Medical, Prescription, Dental and Vision insurance
  • Health Savings Account (HSA), with company contribution of up to $1,000 per year
  • Wellness Programs
  • Free annual flu shots

For a Secure Future

  • Company paid Life and AD&D insurance
  • Company paid long-term disability insurance

For Retirement

  • 403(b) Plan, with clinic contributions for eligible employees

For Career Advancement

  • Education Reimbursement Program
  • Training and development opportunities

For Work Life Balance

  • Generous paid time off, including vacation, sick and personal leave
  • Employee Assistance Program (EAP)- Free and confidential counseling
  • Employee discounts at local spa and on Verizon Wireless services



Demonstrates competency in the application of Medicaid and other regulatory requirements as evident by training materials, monitoring activity documentation and reports.

Completes all necessary paperwork/reports, data input, and primary responsibilities in an accurate, comprehensive, and timely manner according to department standards.

Creates quality-training materials and as appropriate tailors them to department/program specific needs, and provides training feedback forms for presentations.

Conducts an annual review and makes recommendations for revisions to the Quality Plan, Compliance Plan, and related trainings and associated P&Ps, as appropriate.

Conducts concurrent billing verification monitoring activities and quality documentation reviews, monthly verifying clinical necessity.

Assists with the creation and maintenance of a database and expands to accommodate additional compliance indicators, utilizing new software, as available, for storing data and/or report presentation.

Demonstrates the identification of new compliance performance initiatives and works collaboratively to initiate and evaluate.

Drafts new policies and procedures, as appropriate. Provides written communication to supervisors and staff on an ongoing basis regarding quality and accuracy of clinical documentation.

Communicates and interacts with management and other staff effectively and in a professional/collegial manner. Promotes effective working relationships. 

Assists in external audit preparation, management of the audit process, and the response to audit findings.

Continues to develop knowledge and understanding about the history, traditions, values, family systems, and artistic expression of groups served as well as uses appropriate methodological approaches, skills, and techniques that reflect an understanding of culture.

Wheeler Clinic is an EO Employer-M/F/Veteran/Disability.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status, or any other protected class.

Affirmative-Action Equal Opportunity Employer



Job Requirements


BA/BS degree in a behavioral health related field plus 5 years of clinical experience and/or review experience, or a MA/MS degree plus 3 years of clinical experience and/or review experience is required.


Knowledge of Connecticut and Federal regulations, Medicaid requirements and the Joint Commission standards and activities is preferred.


Excellent verbal and written communication skills and proficiency in Microsoft office software is required. 

Job Snapshot

Post Date 11/18/2015
Location Plainville, CT
Employment Type Full-Time
Job Type Health Care, Nonprofit - Social Services, QA - Quality Control
Education 4 Year Degree
Experience At least 3 year(s)
Manages Others No
Relocation No
Industry Social Services, Not for Profit - Charitable, Healthcare - Health Services
Required Travel Not Specified
Job ID 2939
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