Field Compliance & Quality Assurance Specialist
Reports To: Onboarding Manager
Position Type: Full-Time
FLSA Status: [Non-Exempt/Exempt]
Location: Field-Based / Agency Offices / Client Homes
Position Summary
The Field Compliance & Quality Assurance Specialist is responsible for conducting field-based visits, monitoring service delivery, identifying compliance concerns, and supporting the agency's efforts to prevent fraud, waste, abuse, and policy violations.
This position serves as a key quality-control resource by conducting unannounced and scheduled visits with participants, caregivers, and other involved parties. The Specialist will verify that services are being provided appropriately, documentation is accurate, agency policies are being followed, and potential irregularities are identified and reported promptly.
The ideal candidate is observant, professional, detail-oriented, comfortable working independently in the field, and able to address sensitive compliance matters appropriately.
Essential Duties and ResponsibilitiesField Compliance Visits
- Conduct scheduled and unannounced visits to participant residences and other service locations.
- Verify that caregivers are present and providing services as authorized.
- Confirm that services being reported are consistent with the participant's approved service plan and authorized hours.
- Observe the quality and appropriateness of services being delivered.
- Speak with participants and caregivers regarding service delivery, schedules, concerns, and agency policies.
- Identify discrepancies, unusual activity, or potential violations requiring further investigation.
- Document all field visits accurately and objectively.
Fraud, Waste & Abuse Prevention
- Monitor for potential fraudulent activity, falsification of records, unauthorized services, timekeeping irregularities, or other improper conduct.
- Compare reported hours and documentation with information obtained during field visits.
- Identify patterns or discrepancies that may indicate improper billing or service delivery.
- Escalate suspected fraud, waste, abuse, or serious compliance concerns to management in accordance with agency procedures.
- Maintain confidentiality when handling investigations and participant or employee information.
Quality Assurance
- Conduct quality assurance reviews of participant and caregiver records.
- Review documentation for completeness, accuracy, and compliance with applicable requirements.
- Identify trends or recurring deficiencies and communicate findings to management.
- Follow up on corrective actions to ensure identified issues are resolved.
- Assist with internal audits and compliance reviews.
- Provide recommendations for improving service quality and operational compliance.
Participant & Caregiver Interaction
- Maintain professional and respectful communication with participants, caregivers, employees, and representatives.
- Educate participants and caregivers regarding agency policies, service expectations, reporting requirements, and compliance responsibilities when appropriate.
- Receive and document complaints or concerns related to service delivery.
- Report safety, abuse, neglect, exploitation, or other serious concerns through the appropriate agency and regulatory channels.
Documentation & Reporting
- Complete field visit reports, compliance reports, investigation summaries, and quality assurance documentation.
- Maintain accurate records of findings, observations, interviews, and corrective actions.
- Submit reports within established agency deadlines.
- Maintain organized documentation to support internal reviews, audits, investigations, and regulatory inquiries.
- Protect confidential participant, caregiver, and employee information at all times.
Regulatory & Agency Compliance
- Maintain knowledge of applicable OLTL, DOH, MCO, waiver, and agency requirements relevant to assigned responsibilities.
- Monitor compliance with agency policies and procedures.
- Assist management with preparing for audits, reviews, and regulatory inquiries.
- Participate in compliance training and maintain knowledge of changes to applicable regulations and program requirements.
QualificationsRequired
- High school diploma or equivalent; associate or bachelor's degree in healthcare administration, business, social services, compliance, or a related field preferred.
- Experience in healthcare, home and community-based services, human services, quality assurance, compliance, investigations, or a related field preferred.
- Strong attention to detail and ability to identify inconsistencies.
- Excellent written and verbal communication skills.
- Ability to maintain confidentiality and exercise sound judgment.
- Ability to work independently with minimal supervision.
- Ability to handle difficult or sensitive conversations professionally.
- Valid driver's license and reliable transportation.
- Ability to travel throughout the assigned service area and conduct visits in community and residential settings.
Preferred Skills
- Experience with OLTL or waiver-funded services.
- Knowledge of MCO processes and requirements.
- Experience conducting audits, field visits, investigations, or quality assurance reviews.
- Familiarity with electronic visit verification, timekeeping, payroll, or service documentation systems.
- Experience identifying potential fraud, waste, and abuse.
- Strong computer and documentation skills.
- Ability to recognize patterns and investigate discrepancies using available records and information.
Physical & Work Requirements
- Frequent travel to participant homes and community locations.
- Ability to work independently in a field-based environment.
- Ability to communicate effectively with individuals from diverse backgrounds and circumstances.
- Ability to sit, stand, walk, and travel for extended periods as required.
- May occasionally encounter challenging or unpredictable situations and must follow agency safety and escalation procedures.
Key Performance Expectations
The Field Compliance & Quality Assurance Specialist is expected to:
- Conduct thorough and timely field visits.
- Maintain accurate and objective documentation.
- Identify and appropriately escalate compliance concerns.
- Support prevention and detection of fraud, waste, and abuse.
- Protect participant and employee confidentiality.
- Demonstrate professionalism during all participant and caregiver interactions.
- Meet established productivity and reporting expectations.
- Consistently follow agency policies and applicable regulatory requirements.
Equal Employment Opportunity:
Miracle Makers Home Care is an Equal Opportunity Employer and considers qualified applicants without regard to legally protected characteristics.
Pay: $15.00 - $20.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Work Location: On the road
