Compliance Coordinator

Compliance Coordinator

Position Type: Full-Time
Language Requirement: Bilingual English/Spanish
Department: Compliance / Quality Management
Reports To: Program Administrator

Position Summary

The Bilingual Compliance Coordinator is responsible for supporting the organization’s compliance, Quality Management (QM), and Utilization Management (UM) activities within the HCBS-AMH program. This position helps ensure services, documentation, employee practices, and program operations comply with applicable Medicaid, State, Federal, and HCBS-AMH requirements.

The Compliance Coordinator works closely with clinicians, administrators, RM/RME staff, HHSC representatives, hospital social workers, case managers, participants, and other members of the interdisciplinary team to identify and resolve compliance issues, maintain accurate documentation, and support the delivery of high-quality services.

The ideal candidate is detail-oriented, organized, dependable, and comfortable working with regulatory requirements, electronic documentation systems, and multiple deadlines.

Essential Duties and Responsibilities

Compliance & Quality Management

• Monitor and ensure compliance with HCBS-AMH legal policies, program guidelines, Medicaid requirements, and applicable standards of care.
• Review progress notes and other clinical documentation to ensure compliance with State and Federal Medicaid regulations.
• Identify documentation discrepancies, overlapping services, missing information, and other compliance concerns and coordinate timely corrections.
• Monitor and follow up on compliance-related issues and ensure corrective actions are completed.
• Complete and maintain documentation required for QM and UM activities.
• Monitor frequency of services to ensure services are provided and documented in accordance with approved requirements.
• Verify employee timesheets for payroll processing and identify discrepancies as needed.
• Track participant notable dates, CIR submissions, follow-ups, and other required program deadlines.
• Track IRP expiration dates and ensure timely updates and submissions.
• Review IRPs for accurate and complete information.
• Follow up on IRP submissions and approvals.
• Assist with resolving IRP issues, including units, dates, technical issues, and other discrepancies.
• Assist with resolving overlapping services and other documentation or billing discrepancies.
• Complete and maintain HCBS-AMH quarterly and annual reports related to program compliance.

Training & Staff Support

• Monitor required training and ensure staff complete mandatory training updates in a timely manner.
• Assist with the development and updating of training materials for clinicians and other staff.
• Support onboarding activities for new employees and assist with required orientation and training.
• Maintain accurate records of employee training and compliance requirements.
• Provide staff with guidance regarding documentation, program requirements, and compliance expectations.

Coordination & Communication

• Coordinate with RM/RME staff, HHSC representatives, hospital social workers, case managers, clinicians, and other service providers as needed.
• Attend initial and subsequent IDT/IRP meetings and participate in updates and follow-up activities.
• Communicate compliance concerns and required corrective actions to appropriate staff and leadership.
• Assist with problem-solving related to participant services, documentation, IRPs, and program requirements.
• Maintain confidentiality and protect participant and employee information in accordance with applicable laws and organizational policies.

Administrative Support

• Assist with assigning 8x8 phone numbers, laptops, and other required equipment or supplies to new staff.
• Maintain organized compliance and employee records.
• Assist the Program Administrator with audits, reviews, reports, and other compliance-related projects.
• Perform other duties as assigned.

Qualifications

Required

• High school diploma or equivalent; associate or bachelor’s degree in healthcare administration, social services, behavioral health, compliance, or a related field preferred.
• Bilingual in English and Spanish, with the ability to communicate effectively both verbally and in writing.
• Strong organizational and time-management skills.
• Strong attention to detail and ability to identify documentation discrepancies.
• Ability to maintain confidentiality and handle sensitive information professionally.
• Ability to work independently while effectively collaborating with a multidisciplinary team.
• Proficiency with computers, electronic documentation systems, Microsoft Office, and other commonly used administrative software.
• Ability to manage multiple deadlines and prioritize competing responsibilities.

Preferred Experience

• Prior experience working within the HCBS-AMH program is preferred and beneficial to the role.
• Knowledge of HCBS-AMH services and program requirements is a valuable qualification.
• Experience with Medicaid compliance, Quality Management, Utilization Management, behavioral health, case management, or community-based services is strongly preferred.
• Experience reviewing clinical documentation or service records is preferred.

Key Competencies

• Compliance and regulatory awareness
• Attention to detail
• Organization and follow-through
• Problem-solving and critical thinking
• Professional communication
• Team collaboration
• Time management
• Confidentiality and professionalism
• Ability to interpret and apply program requirements

Benefits

Eligible full-time employees receive:

• 401(k) retirement plan
• Medical insurance
• Dental insurance
• Paid Time Off (PTO)

Benefits are subject to applicable eligibility requirements and company policies.