Compliance & Regulatory Affairs Specialist

Dover Health is a regional hospice and home health care provider devoted to helping every senior and their family thrive through personalized and holistic health.

The Compliance & Regulatory Affairs Specialist reporting directly to the Associate General Counsel is responsible for building, managing, and continuously improving Dover Health’s compliance program across its home health, hospice, and palliative care service lines. This role owns all seven elements of an effective compliance program as outlined by the HHS Office of Inspector General’s General Compliance Program Guidance (GCPG), oversees provider, vendor and staff credentialing, leads chart review and audit activities, and ensures ongoing adherence to Medicare and applicable state Medicaid requirements.

The following duties are normal for this position. This list is not to be construed as exclusive or all-inclusive. Other duties may be required and assigned. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

• Draft, maintain, and update compliance policies and procedures that reflect current federal and state regulatory requirements across home health, hospice, and palliative care operations.
• Serve as the designated Compliance Officer; convene and support a Compliance Committee; report regularly to the Associate General Counsel and senior leadership on program status, risks, and corrective actions.
• Develop and deliver role-specific compliance training for clinical, administrative, and operational staff; track completion and address gaps.
• Maintain confidential reporting channels (including a hotline or equivalent mechanism); ensure staff can report concerns without fear of retaliation; investigate and resolve compliance reports in a timely manner.
• Conduct and oversee regular internal audits and monitoring of coding, billing, documentation, and clinical practices; implement risk-based audit schedules; coordinate with external auditors as needed. Maintain and update the compliance risk assessment on at least an annual basis.
• Collaborate with Human Resources to administer and consistently enforce disciplinary standards for compliance violations; advise leadership on corrective action consistent with applicable law and policy.
• Investigate potential violations promptly; design and implement corrective action plans (CAPs); coordinate voluntary disclosure when appropriate; track CAP completion and effectiveness.
• In partnership with agency leadership, ensures organizational compliance with HIPAA and applicable federal and state privacy and security requirements.
• Ensure ongoing compliance with Medicare Conditions of Participation (CoPs) for home health and hospice.
• Monitor regulatory changes from CMS and ensure timely policy and operational updates.
• Oversee Illinois Medicaid and Missouri Medicaid enrollment and compliance requirements specific to home health and hospice services.
• Support preparation for and response to Medicare Administrative Contractor (MAC) audits, RAC audits, and state survey activity.
• Oversee end-to-end state licensing and renewals for all agencies.
• Maintain current enrollment and credentialing files; manage primary source verification processes.
• Monitor OIG exclusion lists and applicable state exclusion databases for all employees, contractors, and vendors on a regular basis for Illinois and Missouri.
• Manage registration and submission of employment credentials for the Illinois Department of Public Health and the Missouri Family Care Safety Registry.
• Lead and conduct prospective, concurrent, and retrospective chart reviews for home health, hospice, and palliative care encounters.
• Evaluate documentation for completeness, accuracy, and compliance with…