Compliance Specialist

  • Job Tracking ID: 512714-709013
  • Job Location: Depew, NY
  • Job Level: Mid Career (2+ years)
  • Level of Education: 2 year degree
  • Job Type: Full-Time/Regular
  • Date Updated: October 28, 2019
  • Years of Experience: 2 - 5 Years
  • Starting Date: ASAP

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Job Description:


Oversees program records and service documentation for all Office of People with Developmental Disabilities (OPWDD) and Adult Career and Continuing Education Services - Vocational Rehabilitation (ACCES-VR) service programs. Performs routine audits to ensure compliance with OPWDD, New York State Department of Education (NYSED), Agency, and other state policies and procedures. Serves as the administrator for the electronic health care records software that is utilized for billing and compliance for the departments that provide OPWDD services. Monitors and evaluates all Employment Services and Day Services admissions and census management processes. Collaborates with other OPWDD services staff to track individual enrollment and movement through services, billing, and electronic records documentation to meet goals that align with annual utilization targets.


  • Manages service documentation, enrollment, discontinuation, and billing on electronic records management software
    • Ensures regulatory compliance for billing standards by monitoring the daily tracking of all services provided
    • Works with department Coordinators to ensure accurate and consistent record keeping across programs on a daily, weekly, and monthly basis
    • Reviews all Staff Action Plans and other service-specific documents/assessments for individuals to ensure regulatory compliance, timeliness, continuity, and comprehensiveness of services to individuals receiving services
    • Review final billing for Community Prevocational Services, Pathway to Employment, OPWDD Supported Employment, and ACCES-VR services, and submits to Finance Department
    • Reports all incidents of billing non-compliance to the department Director and Corporate Compliance Officer
  • In conjunction with the Service Support Specialist, creates a permanent and working file/record for each individual receiving services and ensures compliance with regulatory and Agency requirements
    • Maintains required service-specific program, statistical, and administrative records for assigned individuals receiving services in accordance with regulatory and Agency standards (e.g. production rates and earnings)
    • Updates and keeps current files for OPWDD required assessments for employment services
  • Conducts routine internal record reviews to ensure compliance with various regulations (e.g. OPWDD, OMIG)
    • Reports findings, identifies trends, and areas for improvement to the Compliance Officer and appropriate Service Director
    • Monitors to ensure a Response/Corrective Action Plan is submitted
    • Identifies, completes and submits voids on any Medicaid claims to the appropriate Service Director
  • Orchestrates and reviews peer audits
    • Initiates an internal record review when peer audit findings necessitate the need
  • Serves as Administrator for Therap, Case Ware, CHOICES, and any other software used for billing/compliance
    • Conducts monthly user audits for Therap, Case Ware, and CHOICES to make sure that staff are added and removed as necessary
    • Works with leadership team to address and resolve ongoing issues regarding efficient and accurate operations of the electronic records management software
    • Maintains mailing/contact information for all individuals receiving services, their families, and care providers, using the appropriate electronic records management software
    • Maintains accurate counts of individuals in each service and for non-duplicated services
    • Enrolls and trains new staff on the electronic record management software
    • Assigns and maintains accurate controls on levels of access into the system
  • Maintains accurate dada on new/discontinued individuals receiving services and ensures services are approved by OPWDD
    • Works with department Coordinators regarding all changes to the status of an individual receiving services
    • Coordinates information to ensure correct, comprehensive data management; accurate and timely billing; as well as service provision
    • Submits DDP-1 forms as needed on CHOICES for new enrollments and discharges
    • Ensures intakes and terminations are completed through OPWDD’s CHOICES system
    • Notifies appropriate office and billing staff regarding new admissions
  • Provides initial and ongoing training to Employment Services and Day Services staff regarding compliance standards with required documentation of the daily and monthly accounting of services delivered
  • Works with the Director of Information Technology on creating enhanced systems management solutions that allow effective, cohesive information transfers across departments, including billing and finance
  • Serves as the backup for the Service Support Specialist, to assist with filing and transportation coordination.
  • Consistently complies with all Agency policies and procedures.
  • Consistently maintains high performance standards at work with regard to personal behavior and interactions with staff, individuals and outside agencies.
  • Performs other duties as assigned.

Experience and Skills:


  • Strong organizational skills
  • High attention to detail
  • Ability to work with others and as part of a team
  • Ability to work independently
  • Good time management skills
  • High level of written and oral communication skills
  • Strong computer skills and extensive knowledge with using word processing, database and spreadsheet programs


Preferred: Bachelor’s Degree in Business, Human Services, or related area and three (3) years of experience with the provision of OPWDD services, quality assurance / improvement activities, auditing, and/or regulatory compliance. Experience as a health records administrator, or in the back-end set up of Therap as plus. Experience with OMIG (Office of Medicaid Inspector General) compliance activities a plus.

Minimum: Associates Degree in related field or combination of education and equivalent experience

Valid New York State driver’s license in good standing, New York automobile insurance, and a reliable motor vehicle required.

Job Benefits:

We offer an exceptional benefits package:

  • Paid Time Off
  • Holidays
  • Health Insurance
  • Dental Insurance
  • Life Insurance
  • Aflac: Cancer and Short Term Disability Coverage
  • 401 (k)
  • and more!!



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