The Regulatory Compliance and Coverage Specialist will report to the Director of Regulatory Compliance and Quality Review. The Regulatory Compliance and Coverage Specialist will complete detailed compliance reviews of all Aveanna locations. This role must be knowledgeable of Aveanna policies and procedures as well as Federal, State and Local regulations governing healthcare. The Regulatory Compliance and Coverage Specialist will monitor, analyze, and assess risk in all lines of business using standardized tools and available reporting metrics. This role will facilitate collaboration between the compliance department and all other clinical and operational departments within Aveanna Healthcare.
Essential Job Functions
- Performs onsite audits reviews in all lines of business within the Aveanna family of companies to identify risk and best practices involved in maintaining overall compliance
- Utilizes standardized evaluation methods and tools approved the Aveanna Compliance Department to ensure quality and establish trust and integrity in the Aveanna Internal Review process.
- Delivers timely reporting of internal reviews. Monitors for quality and consistency of findings between internal reviewers across all regions
- Provides education and feedback to locations related to OASIS and ICD Coding requirements
- Provides guidance, training, and ongoing support to all Aveanna locations
- Collaborates with other members of Aveanna Compliance Department to maintain reliability of the Aveanna Internal Review
- Pursues knowledge of current rules and regulations that impact all lines of business
- Provides support and coaching during the corrective action plan process to validate progress to goals
- Maintains a collaborative relationship with other Aveanna leaders to become knowledgeable of new initiatives and programs
- Provides education to Aveanna leadership regarding Aveanna Compliance initiatives and processes
- Provides risk assessments and education to leaders related to Federal, State, and local regulations
- Contributes to the Aveanna Compliance Department by presenting accurate and timely reporting of risks and making recommendations for improvements to policies and procedures to enhance compliance
- Bachelor's degree in Nursing or Therapy (or equivalent plus a minimum of 2 years clinical experience)
- Current license as an RN
- Thorough knowledge of the home care industry, Medicare and Medicaid coverage requirements, clinical and operations practices, and a broad understanding of the Federal, State, and local regulatory requirements.
- Must be knowledgeable in OASIS and diagnosis coding, certification preferred
- Minimum of 2 years managerial experience
- Minimum of 2 years experience in healthcare compliance related activities (clinical record review, quality assurance, performance improvement, auditing, or utilization review)
Apply on company website