Horizon House is an Equal Opportunity Employer (M/F/Veteran/Disability/Sexual Orientation/Gender Identity).

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Compliance Specialist

Req Code: 2024:1120-001

County: Philadelphia County, PA

FT/PT: Full Time

Location: 1120-Compliance

Schedule: Monday - Friday (9am to 5pm)

Job Description/Essential Functions:

Horizon House, Inc. is a nationally recognized provider of services to adults with support needs due to developmental disabilities, behavioral health issues, and substance abuse. Horizon House is Pennsylvania's oldest psychiatric rehabilitation agency. Since 1952, we have been dedicated to helping people with mental illness, drug and alcohol addictions, developmental/intellectual disabilities, and homelessness to stabilize their lives and to help them live as independently as possible in the community. With over 100 locations throughout South and Northeastern Pennsylvania and the state of Delaware, Horizon House provides services to a diverse population focusing on individual strength and choice.

We are seeking a qualified Compliance Specialist to join our agency. The position is responsible for the compliance monitoring of service documentation against claims. Some of the responsibilities include: Performs compliance audits of randomly selected claims on a periodic basis to test for the required components of valid claim documentation and collaborate with Director of Organizational Quality and Compliance on the results. Reviews clinical records for key measures to support billing. Establishes and maintains a random quarterly compliance audit schedule for billed services. Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future. Assists in the development and implementation of compliance programs for the organization. Oversee issues and provides general guidance on how to avoid or deal with similar situations in the future. Oversees Compliance Hotline and assures investigations or appropriate actions are taken for potential compliance violations. dance on how to avoid or deal with similar situations in the future. Ensures that training provided on compliance policies, procedures and documentation standards are thorough, and accurately documented.

Job Qualifications:

The successful candidate will have the following:

Bachelor's Degree (B.A. or B.S.) or an equivalent combination of education and training that would provide the level of knowledge, skill and ability required. At least 2 years of compliance/claims experience in the Behavioral Health field Proficient in computer applications (including MS Office). Knowledge of statistics, data collection, analysis and data presentation. Familiarity with compliance review processes. Ability to work independently, exercise problem-solving skills, and detail oriented. Must have a valid driver's license and acceptable driving record. Scope: Required sitting for long periods of time. Light lifting and/or carrying, not to exceed 25 lbs. Frequent talking and listening. Manual dexterity and fine motor skills. Available for travel to various locations at varying times

Horizon House offers competitive compensations and a comprehensive benefit package including: medical & dental, (9) nine paid holidays, paid time off, tuition reimbursement, retirement savings plan, voluntary tax-sheltered annuity, transit benefit program, opportunities for advancement and more.

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Horizon House is an Equal Opportunity Employer : M/F/Veteran/Disability/Sexual Orientation/Gender Identity

Horizon House is an equal opportunity employer. In accordance with applicable law, Horizon House considers qualified applicants for positions without regard to   ace, color, religious creed, gender identity, marital status, military status, ancestry, national origin, English Limited Proficiency (LEP), age, sex, pregnancy, genetic information, sexual orientation, gender identity or expression, ethnicity, source of income, familial status, domestic or sexual violence victim status, LGBTQ, AIDS or HIV status, union membership,  veteran status, psychiatric disability, other disability or other legally protected status. Reasonable accommodation is available during the application process upon request without penalty.  Horizon House is committed to these principles in our employment practices.