Quality & Compliance Specialist

Confidential Employer | North CarolinaRemote with Monthly Travel to Eastern North CarolinaFull-Time or Part-Time/Fractional OpportunityA growing behavioral health organization serving North Carolina Medicaid members is seeking an experienced Quality & Compliance Specialist to lead quality assurance, regulatory compliance, utilization review, and audit readiness. The employer's identity will be shared with qualified candidates as they advance through the recruitment process.#BehavioralHealthJobs #NCMedicaid #HealthcareCompliance #QualityAssurance #NorthCarolinaJobs.

Confidential Employer | North CarolinaRemote with Monthly Travel to Eastern North CarolinaFull-Time or Part-Time/Fractional OpportunityA growing behavioral health organization serving North Carolina Medicaid members is seeking an experienced Quality & Compliance Specialist to lead quality assurance, regulatory compliance, utilization review, and audit readiness.This role is ideal for a proactive compliance professional who understands NC Medicaid, LME/MCOs, Tailored Plans, DHHS requirements, clinical documentation, and behavioral health billing compliance. You do not wait for an audit to uncover a problem. You know how to identify risks, strengthen processes, and help teams correct concerns before they become findings.What You'll DoConduct clinical documentation reviews and ongoing chart auditsManage the organization's Quality Assurance and Quality Improvement PlanPrepare for Medicaid, MCO, DHHS, DHSR, and other regulatory auditsIdentify compliance risks and develop corrective action plansMonitor corrective actions through completionTrack documentation trends and recurring compliance concernsMonitor regulatory updates from NC Medicaid, DHHS, Tailored Plans, and LME/MCOsMaintain compliance policies, procedures, and staff guidanceReview service authorizations and reauthorizations to prevent coverage gapsPartner with billing to address documentation, denial, and reimbursement concernsConfirm that billed services are supported by compliant documentationManage client grievances and compliance-related complaintsMonitor required reporting, including NC IRIS and NC TOPPSSupport compliant EHR workflows and system improvementsProvide leadership with regular compliance findings, trends, and recommendationsWhat We're Looking ForBachelor's degree in Human Services, Healthcare Administration, Behavioral Health, Social Work, or a related field; equivalent relevant experience may be consideredAt least three years of experience in behavioral health Medicaid compliance, QA/QI, utilization review, or a related role with a North Carolina providerStrong knowledge of NC Medicaid behavioral health requirements, including Clinical Coverage Policy 8AUnderstanding of outpatient mental health and substance use services, documentation standards, staffing, and credentialingExperience with NC LME/MCOs, Tailored Plans, NCTracks, and authorization systemsExperience preparing for Medicaid, MCO, DHHS, or similar regulatory auditsExperience developing and monitoring corrective action plansStrong understanding of clinical documentation and billing complianceAbility to translate regulatory requirements into practical policies and workflowsStrong communication, organization, and analytical skillsAbility to work independently and follow compliance concerns through resolutionPreferred ExperienceBehavioral health compliance or QA/QI leadershipSubstance use treatment programsNC TOPPS and NC IRIS reportingEHR implementation or optimizationCARF or similar accreditation standardsPolicy development and compliance trainingCompliance dashboards and reporting toolsCHC, CPHQ, or similar quality or compliance certificationCompensationFull-Time: $60,000-$95,000 annually, depending on experience and qualifications.Benefits include health, dental, and vision coverage; paid time off; mileage reimbursement for required travel; and professional development support.Part-Time/Fractional Contractor: $35-$75 per hour, depending on experience and scope.Location and TravelThis is a remote-first position for candidates residing in North Carolina. Travel to Eastern North Carolina is required at least once per month and occasionally for audits, site reviews, training, and leadership meetings.Candidates located in Eastern North Carolina are strongly preferred. Reliable transportation and successful completion of required Medicaid exclusion screenings are required.Ready to Apply?Please submit your resume and a brief summary of your experience with North Carolina Medicaid behavioral health compliance, quality assurance, and regulatory audits.The employer's identity will be shared with qualified candidates as they advance through the recruitment process.#BehavioralHealthJobs #NCMedicaid #HealthcareCompliance #QualityAssurance #NorthCarolinaJobs

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