Position Overview
Reporting to the Chief Financial Officer (CFO) with a strong partnership with the Chief Program Officer (CPO), the Director of Quality and Medicaid Compliance plays a pivotal role at Renaissance Social Services, Inc. (RSSI).
This director will oversee all facets of quality assurance, compliance, and Medicaid billing integrity, ensuring the organization maintains full compliance with all regulatory requirements as well as CARF accreditation standards.
The Director will drive organization-wide excellence by developing data-driven quality initiatives, strengthening compliance infrastructure, and cultivating a culture of accountability and transparency all that align with RSSI’s mission to end homelessness and improve lives.
Key Responsibilities
1. Medicaid Compliance and Billing Oversight
Oversee the agency’s Medicaid compliance program to ensure billing accuracy, documentation integrity, and timely reimbursement.
Monitor and interpret federal, state, and managed care regulations to maintain ongoing compliance.
Serve as the primary liaison for Medicaid and program regulatory audits, surveys, and inspections, managing all documentation and responses.
Lead internal audits, manage Medicaid-related surveys or inspections, and coordinate organizational responses.
Collaborate with Finance and Program teams to align billing practices with quality and compliance goals.
2. Quality, Accreditation, and Risk Management
Lead all CARF accreditation activities, including preparation, coordination, and follow-up, and ensure the organization remains ready to meet standards at all times.
Develop and track key performance indicators (KPIs) that reflect service quality, compliance, and client outcomes.
Ensure the organization is always audit-ready and aligned with evolving regulations, Medicaid standards, and accreditation requirements. Including reviewing, revising, developing and implementing organizational policies and procedures to align with best practices and regulatory bodies.
Conduct quality reviews and analyze data to identify areas for improvement and reduce compliance and organizational risks.
Analyze trends and performance data to identify opportunities for improvement and report findings to executive leadership and the Board.
3. Continuous Improvement and Training
Partner with Program, Finance, and HR leaders to integrate quality and compliance practices across departments.
Oversee the utilization review process and conduct internal audits and chart reviews to ensure compliance, quality of documentation, and billing accuracy.
In coordination with the CPO and Program Directors, develop and track key performance indicators (KPIs) tied to service quality, compliance, and client outcomes.
Provide staff training, tools and coaching at all levels to strengthen understanding of compliance, quality standards and promote accountability.
Gather feedback from staff, clients, and partners to guide ongoing improvement efforts.
Qualifications
Bachelor's degree in social services, Healthcare Administration, Public Health, or related field; LCSW is strongly preferred.
Knowledge of Medicaid regulations, managed care systems, and quality improvement frameworks.
Experience leading CARF or equivalent accreditation and managing compliance audits.
Strong analytical, communication, and training skills, with the ability to collaborate across departments.
Commitment to Renaissance’s mission, values, and organizational excellence.