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Compliance Specialist - Registered Nurse / RN - Northeast

Compliance Specialist - Registered Nurse / RN - Northeast

Job Description

Maxim Healthcare Services is currently seeking qualified applicants for the role of a Compliance Specialist - Registered Nurse - RN. The primary responsibility of the Compliance Specialist is to review clinical medical records and claims for accuracy of services related to home health care.  The Compliance Specialist maintains a comprehensive understanding of ethical principles and independence in their work, professional conduct, duty, and responsibilities.  The Compliance Specialist is obligated to articulate principles, have a working knowledge of the rules and regulations as they pertain to all aspects of home healthcare, and observe/ensure the highest level of professional standards, quality care, and legal aspects.
Essential Duties and Responsibilities\:
  • Reviews clinical medical records 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, providing information generated from a sound basis
  • Ensures confidentiality of medical information related to HIPAA regulations
  • Displays dedication to corporate objectives
  • Performs audits as scheduled by the Compliance Leadership team
  • 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
  • Assists with clinical review for claims testing activities
  • Assists with clinical review for issues investigation and resolution
  • Performs other duties as assigned/necessary
Maxim Healthcare Services is one of the leading providers of medical staffing, home health and wellness services in the United States.  Founded in 1988, Maxim has rapidly expanded to include 12 divisions and over 400 branch offices in 44 states and the District of Columbia.  We have earned a position as an innovative leader in the healthcare industry through our emphasis on quality patient care, compliance initiatives and customer service.  Today, Maxim is one of the largest privately owned companies in our industry.
Maxim has committed itself to achieving exemplary corporate citizenship, best practices of effective corporate governance, the highest levels of integrity and professionalism, integrity in the operation of federal healthcare programs, and a culture of openness, accountability and compliance throughout Maxim.

Job Requirements

Minimum Requirements\:
  • RN/BSN degree or other commensurate healthcare degree
  • Experience in Utilization Review, Risk Management, Quality Management, Documentation Specialization, Nurse Management, Compliance, Billing, Coding, or CFE, LNC, or CPUR certification
  • At least five years of clinical experience - Critical Care/Home Health Care preferred
  • Demonstrated knowledge of Clinical Compliance, Best Practices, Medical Record Review, Legal Aspects of Documentation, etc
  • Demonstrated knowledge of CPT, ICD-9 codes, DRGs, and APC coding
  • Understanding of payer rules and regulations, including Medicare and Medicaid
  • Ability to set priorities and meet timelines for performance expectations, while maintaining strong attention to detail
  • Ability to work independently with minimal supervision, and demonstrate initiative
  • Excellent interpersonal and communication skills
  • Must demonstrate sound judgment and decision-making
  • Must successfully articulate rationale and deliver difficult messages in a constructive manner; must be diplomatic in the face of adversity
  • Computer proficiency, including programs such as MS Office, Word, Excel, email, and internet research, required
  • Must be ethical and possess the ability to remain impartial and objective
  • Must exemplify strong, positive leadership skills
  • Must possess the ability to educate and train Compliance and Clinical standards to staff members
  • Must be able to travel 80-90% of the work time
  • Must demonstrate character that enhances corporate interests and integrity
  • Ability to effectively elicit/provide information to and from appropriate individuals (including, but not limited to, supervisors, co-workers, clients) via strong communication skills; proficiency in the English language may be required

Our company is committed to maintaining a challenging environment that promotes personal accountability, personal growth, and an active role in the driving vision of the company. We offer competitive pay, full benefits including medical, dental and vision coverage as well as 401(k), 529 college savings plan, basic life insurance with the option of supplemental, and 17 days paid time off in addition to holidays and two floating holidays.

To learn more about Maxim Healthcare Services, please visit our website and apply online at
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Job Snapshot

Employment Type Full-Time
Job Type Health Care
Education 4 Year Degree
Experience Not Specified
Manages Others Not Specified
Industry Healthcare - Health Services
Required Travel Not Specified
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Compliance Specialist - Registered Nurse / RN - Northeast

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