Compliance Specialist Revenue Cycle

About Vitra Health

Vitra Health is a mission-driven healthcare organization committed to improving the quality of life for individuals and families across Massachusetts. Through innovative home- and community-based services, Vitra supports aging adults, people with disabilities, and individuals with complex care needs— supported by a Nurse, and Case Manager, Vitra ensures clients receive compassionate, personalized, and dignified care.

To help share our mission and expand our community impact, Vitra Health is seeking a Compliance Analyst who is passionate about community engagement and helping people access the care and resources they deserve.

The Opportunity

As a Compliance Specialist with Vitra Health's, you will support the day-to-day operations of the Compliance Department by helping maintain regulatory and accreditation standards across the organization. You will assist with internal audits, regulatory reporting, risk management activities, and compliance training coordination.

This role plays a key part in promoting a culture of compliance by ensuring timely communication, accurate documentation, and effective follow-through on compliance initiatives. The ideal candidate is mission-minded, detailed oriented, highly organized, and able to maintain the confidentiality of sensitive information.

Key Responsibilities

Compliance Program Support:

• Support the Compliance Officer and Compliance Manager in implementing and maintaining the organization's compliance program and compliance workplan
• Monitor regulatory changes and assist with updates to policies, procedures, and internal controls
• Maintain compliance documentation, tracking tools, and audit logs
• Support internal and external audits, reviews, and regulatory inquiries
• Track and assist with preparing external compliance reports to regulators, payers, and accreditation bodies.
• Lead or coordinate compliance-related projects, including system enhancements, process improvements, and special initiatives
• Perform other tasks as assigned

Monitoring, Risk Assessment & Review:

• Execute risk-based monitoring across clinical, documentation, and billing functions
• Identify and prioritize regulatory and financial risk areas within AFC, GAFC, and ADH programs
• Perform periodic and targeted reviews of medical records, service documentation, and claims
• Validate alignment between authorized services, care plans, documentation, and billed claims
• Analyze data trends and variances to detect anomalies and potential compliance concerns
• Maintain clear, organized workpapers to support review activities

Fraud, Waste, and Abuse:

• Evaluate key revenue cycle controls, including authorizations, documentation support, and claims accuracy
• Conduct audits of claims, billing processes, and related documentation to ensure compliance with regulatory and payer requirements
• Identify systemic issues contributing to billing errors, denials, or compliance risk
• Assess root causes of discrepancies, including overpayments, underpayments, and documentation gaps
• Recommend control enhancements to strengthen billing integrity and reduce risk exposure

Issue Evaluation & Reporting:

• Document and communicate findings in clear, actionable reports
• Assess and classify issues based on risk and regulatory impact
• Track and validate corrective actions to ensure effective resolution
• Escalate significant concerns in accordance with established protocols

Regulatory Alignment & Audit Readiness:

• Interpret and apply federal, state, and payer requirements to monitoring activities
• Support readiness for external audits, surveys, and regulatory reviews
• Maintain awareness of changes impacting AFC/GAFC/ADH programs, Medicaid billing, and documentation standards

Education, Advisory Support, & Mission:

• Provide guidance based on review findings to support consistent interpretation of requirements
• Maintain training records and assist in developing or updating training materials.
• Support cross-functional teams in preparing for audits and responding to surveyor requests
• Foster culture of customer service and commitment to quality care.
• Serve as a brand ambassador for Vitra reflecting our vision, mission, and values.
• Show genuine interest and compassion for the communities we serve and commitment to the diversity of our clients and team members.

What we are looking for:

• Bachelor's degree in healthcare administration, public Health, legal studies, business administration, or a related field preferred.
• Certifications in one or more of the following preferred: Certified in Healthcare Compliance (CHC) Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or willingness to obtain in 6 months.
• Minimum of two years of experience in healthcare compliance, regulatory affairs, or a similar role required.
• Experience reviewing documentation, claims, or billing processes in a regulated environment
• Familiarity with healthcare regulations including HIPAA, CMS, NCQA, and OIG guidelines strongly preferred.
• Experience with electronic medical records, learning management systems, compliance tracking tools, or risk management platforms preferred.
• Strong command of Microsoft Excel and Microsoft PowerPoint.
• Strong organizational, analytical, and communication skills.
• Ability to manage confidential and sensitive information with integrity and discretion.
• Potential for occasional travel between office locations, especially during external audits or inspections.

Work Environment and Physical Requirements

• Office-based work in a clean well-lit environment with fluctuating temperatures near others.
• Client-facing field staff and community liaisons require frequent travel to client homes or community settings; ability to drive safely; work in client homes may involve varying temperatures, odors, allergens, pets, and other environmental factors.
• Requires substantial periods of repetitive work utilizing a computer, monitor, keyboard, and mouse.
• Requires lifting and carrying equipment and supplies weighing up to 35 pounds; requires pushing and pulling equipment and supplies weighing up to 35 pounds; requires walking and standing; requires frequent sitting more than 75% of the workday; requires the ability to negotiate stairs; requires visual acuity and manual dexterity to operate equipment.

Perks and Benefits:

• Employer sponsored health Insurance with a generous employer match.
• Dental and Vision Benefits.
• Supplemental Benefits
• Life, Accident, Critical Illness and Disability Insurance.
• 401K with a 5% company match.
• Accrued Paid-Time-Off.
• Ten company paid holidays.
• Wellness Benefits.
• Tuition Reimbursement.
• Supportive team structure and company culture with a focus on work/life balance.

Vitra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.