Quality & Compliance Specialist

Quality & Compliance Specialist - Behavioral Health

Confidential Employer | North Carolina
Remote with Monthly Travel to Eastern North Carolina
Full-Time or Part-Time/Contract Opportunity

A growing behavioral health organization serving Medicaid members in North Carolina is seeking an experienced Quality & Compliance Specialist to oversee quality assurance, regulatory compliance, audit readiness, utilization, and related compliance functions.

This is a key position for an experienced behavioral health compliance professional who understands NC Medicaid requirements, LME/MCOs, Tailored Plans, DHHS regulations, clinical documentation standards, and audit preparation .

The position is primarily remote; however, candidates must be based in North Carolina and available to travel to Eastern North Carolina at least once per month, or as needed. Candidates currently located in Eastern North Carolina are strongly preferred.

What You'll Be Responsible For

The Quality & Compliance Specialist will independently manage the organization's quality and compliance activities, including:

- Leading ongoing chart audits and clinical documentation reviews

- Maintaining and executing the organization's Quality Assurance/Quality Improvement Plan

- Preparing the organization for MCO, DHHS, DHSR, and Medicaid audits and reviews

- Identifying compliance risks and developing corrective action plans

- Monitoring corrective actions through completion

- Tracking documentation quality, trends, and recurring compliance concerns

- Monitoring NC Medicaid, DHHS, Tailored Plan, and MCO regulatory updates

- Maintaining compliance-related policies and procedures

- Reviewing service authorizations and reauthorizations to prevent gaps in coverage

- Partnering with billing to identify documentation, denial, and reimbursement concerns

- Ensuring billed services are supported by compliant documentation

- Managing client grievances and compliance complaints

- Monitoring required incident and regulatory reporting, including NC IRIS and NC TOPPS

- Supporting EHR workflows and configuration from a compliance perspective

- Providing regular compliance reports, findings, and recommendations to senior leadership

What We're Looking For

Qualified candidates should have:

- Bachelor's degree in Human Services, Healthcare Administration, Behavioral Health, Social Work, or a related field; equivalent relevant experience may be considered

- At least 3 years of experience in behavioral health Medicaid compliance, QA/QI, utilization review, or a closely related role with a North Carolina provider

- Strong working knowledge of NC Medicaid behavioral health requirements , including Clinical Coverage Policy 8A

- Knowledge of outpatient mental health and substance use service definitions, documentation standards, staffing, and credentialing requirements

- Experience working with NC LME/MCOs and Tailored Plans

- Working knowledge of NCTracks and MCO authorization/utilization systems

- Experience conducting or preparing for Medicaid, MCO, DHHS, or similar regulatory audits

- Experience developing and monitoring corrective action plans

- Strong understanding of clinical documentation and billing compliance

- Ability to interpret regulatory requirements and translate them into practical policies, procedures, and workflows

- Strong written and verbal communication skills

- Ability to work independently, prioritize competing compliance needs, and follow issues through resolution

Preferred Experience

Additional consideration will be given to candidates with experience in:

- Behavioral health compliance or QA/QI leadership

- Substance use treatment programs

- NC TOPPS and NC IRIS reporting

- EHR implementation or optimization

- CARF or similar accreditation standards

- Developing policies, procedures, and staff training materials

- Compliance dashboards, spreadsheets, and reporting tools

- CHC, CPHQ, or similar compliance/quality credentials

Compensation

Full-Time: $60,000-$95,000 annually, depending on experience and qualifications.

Full-time benefits include health, dental, and vision coverage; paid time off; mileage reimbursement for required travel; and professional development support.

Part-Time/Fractional Contractor: $35-$75 per hour, depending on experience and scope of engagement.

Location & Travel

This is a remote-first North Carolina position with required travel to Eastern North Carolina at least monthly and occasionally as needed for audits, site reviews, staff training, and leadership meetings.

Candidates must have reliable transportation and be able to successfully complete required Medicaid exclusion screenings.

Ideal Candidate

The ideal candidate is someone who doesn't wait for an audit to identify a problem. You know how to look at documentation, systems, and processes, identify potential compliance risks, and work with teams to correct them before they become findings.

You should be comfortable owning the compliance function with a high degree of independence while keeping leadership informed of significant risks, trends, and recommended actions.

To Apply

Please submit your resume along with a brief summary of your experience with North Carolina Medicaid behavioral health compliance, quality assurance, and regulatory audits .

Employer information will be shared with qualified candidates as they advance through the recruitment process.

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