Quality & Compliance Specialist

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

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

This role is ideal for a proactive compliance professional who understands NC Medicaid, LME/MCOs, Tailored Plans, DHHS requirements, clinical documentation, and behavioral health billing compliance. You do not wait for an audit to uncover a problem. You know how to identify risks, strengthen processes, and help teams correct concerns before they become findings.

What You'll Do

Conduct clinical documentation reviews and ongoing chart audits

Manage the organization's Quality Assurance and Quality Improvement Plan

Prepare for Medicaid, MCO, DHHS, DHSR, and other regulatory audits

Identify compliance risks and develop corrective action plans

Monitor corrective actions through completion

Track documentation trends and recurring compliance concerns

Monitor regulatory updates from NC Medicaid, DHHS, Tailored Plans, and LME/MCOs

Maintain compliance policies, procedures, and staff guidance

Review service authorizations and reauthorizations to prevent coverage gaps

Partner with billing to address documentation, denial, and reimbursement concerns

Confirm that billed services are supported by compliant documentation

Manage client grievances and compliance-related complaints

Monitor required reporting, including NC IRIS and NC TOPPS

Support compliant EHR workflows and system improvements

Provide leadership with regular compliance findings, trends, and recommendations

What We're Looking For

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

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

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

Understanding of outpatient mental health and substance use services, documentation standards, staffing, and credentialing

Experience with NC LME/MCOs, Tailored Plans, NCTracks, and authorization systems

Experience 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 translate regulatory requirements into practical policies and workflows

Strong communication, organization, and analytical skills

Ability to work independently and follow compliance concerns through resolution

Preferred Experience

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

Policy development and compliance training

Compliance dashboards and reporting tools

CHC, CPHQ, or similar quality or compliance certification

Compensation

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

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.

Location and Travel

This is a remote-first position for candidates residing in North Carolina. Travel to Eastern North Carolina is required at least once per month and occasionally for audits, site reviews, training, and leadership meetings.

Candidates located in Eastern North Carolina are strongly preferred. Reliable transportation and successful completion of required Medicaid exclusion screenings are required.

Ready to Apply?

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

The employer's identity will be shared with qualified candidates as they advance through the recruitment process.

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