NorthStar OTP Compliance Specialist chez The Cowlitz Indian Tribe

POSITION TITLE: Compliance Specialist
DEPARTMENT: Health & Human Services (HHS) - OTP Clinic
LOCATION: Vancouver, WA (on-site)
REPORTS TO: Clinic Director
FLSA STATUS: Nonexempt, fulltime
WAGE RANGE: $33.40 - $40.10 per hour

Closing Date: September 16, 2025

***If you are an American Indian/Alaska Native and/or a Veteran and would like this to be considered preference in hiring, please upload documentation with your resume and cover letter. Acceptable documentation includes Tribal Enrollment card, a letter from your Tribe stating your enrollment, or BIA 4432 and/or DD214.***

Position Summary:

Achieves the Clinic�s goals and objectives by ensuring departmental adherence to state and federal regulations by reviewing guidelines, auditing charts, and verifying that documentation and coding within the electronic health record (EHR) meet legal and insurance requirements. Supports timely reimbursement for services, prepares files for audits, and provides training and guidance to staff on proper documentation. Collaborates with leadership, CPCO, and billing staff to maintain compliance and align practices with regulatory standards. Adheres to HIPAA and confidentiality requirements. Honors and represents the mission, vision, values of CIT and of the HHS department.

This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive.

Essential Duties & Responsibilities:

• Attends team and leadership meetings to ensure all federal and state compliance requirements are met.
• Performs regular audits of charts and other departmental required actions to ensure adherence to all requirements.
• Makes recommendations to department leadership regarding policy and procedural changes.
• Stays current on all federal and state requirements for department and reports to leadership regarding any required changes in policy or procedures.
• Ensures that all charts include necessary paperwork to meet state and federal regulations; when charts do not include required documentation, coordinates with department leadership on corrective action plan.
• Writes Corrective Action Plan for identified deficiencies within department.
• Reviews client charts for accuracy of diagnoses and procedures.
• Reviews behavioral health charts to verify accurate CPT, ICD-10, and HCPCS coding; ensure compliance with documentation and time requirements; and confirm that interventions, including evidence-based practices, are properly recorded.
• Assists EHR and billing staff in identifying and recommending codes to be utilized.
• Assigns appropriate codes to diagnoses or services.
• Obtains necessary clarification of information regarding notes and charts to ensure correct coding and compliance with state and federal regulations.
• Maintains departmental best practice productivity and quality standards.
• Trains staff on proper service selection, time documentation, and chart requirements to meet state and federal requirements.
• Discusses coding questions with supervisor and billing staff and reports unusual occurrences to Clinic Director.
• Runs routine reports, develops tracking measures, and follows-up to ensure departmental compliance with state and federal regulations.
• Conducts auditing tasks as assigned.
• Prepares files for state, insurance, or federal audits, as needed.
• Adheres to HIPAA and confidentiality requirements.
• Maintains technical knowledge by conducting research, attending seminars, educational workshops, classes and conferences; reviewing professional publications; establishing networks; participating in professional societies; conferring with representatives of contracting agencies and related organizations.
• Adapts to changes in safety protocols and procedures.
• Contributes to a team effort and accomplishes related results as required.
• Performs other duties as assigned.

Knowledge, Skills, and Abilities:

• Knowledge of traditional form of government and tribal customs and traditions.
• Knowledge of ICD-10, DSM-IV, CPT, and HCPCS universal coding systems.
• Knowledge of federal and state regulations (WAC, RCW, HIPAA, Medicare/Medicaid) governing health care documentation and billing procedures.
• Knowledge of Correct Coding Initiatives (CCI) compliance regulations.
• Knowledge of insurance and reimbursement requirements.
• Knowledge and familiarity with the mandatory reporting requirements under the Indian Child Protection Act, with regards to suspected incidence of child abuse or child neglect.
• Skill in operating various word-processing, spreadsheets, database software programs in a Windows environment.
• Skill in Electronic Health Record (EHR) systems, medical terminology, and coding workflows.
• Skill in conducting chart audits and identifying errors or compliance gaps.
• Skill in analyzing and problem-solving to resolve coding and documentation issues.
• Ability to interpret and apply state, federal, and insurance regulations to clinical documentation.
• Ability to pay close attention to detail while reviewing high volumes of documentation.
• Ability to adapt to regulatory changes and update processes accordingly.
• Ability to work both independently and in a team environment.
• Ability to communicate effectively both verbally and in writing.
• Ability to establish and maintain professional relationships with individuals of varying social and cultural backgrounds and with co-workers at all levels.
• Ability to maintain confidentiality.
• Ability to create and present effective speeches and presentations.
• Ability to analyze situations and adopt appropriate courses of action.
• Ability to establish and maintain professional relationships with the public and co-workers.
• Ability to make solid decisions and exercise independent judgment.

Minimum Qualifications:

• Associate�s Degree in Healthcare Information Management, Health Information Technology, Medical Coding/Billing, Healthcare Administration, Allied Health Sciences, or related field.
• Four (4) years of compliance experience; auditing experience preferred.
• A combination of relevant education and experience may be considered.
• Valid driver�s license is required when driving vehicles for work-related purposes.
• Must be able to successfully pass a background screening / investigation according to the established requirements below.

Tribal preference in accordance with Cowlitz Indian Tribe Code and CIT Employee Policies and Procedures Handbook shall apply to all positions. All positions are required to adhere to CIT�s established safety policies regarding vaccine requirements and personal protective equipment (PPE).

Background Investigation Requirements:

• Pre-employment drug screen.
• Reference checks, education and employment verification.
• Federal, state, and/or tribal criminal history and sanction checks.

Physical Demands:

While performing the duties of this job, the employee regularly is required to sit; use hands to finger, handle, or feel; and talk or hear. The employee occasionally is required to stand; walk; and reach with hands and arms. The employee is occasionally required to lift up to 20 pounds. Specific vision abilities required by this job include close vision and clarity of vision at long distance.

Work Environment:

Work is performed in a clinic/office environment. Employee may be exposed to unpleasant odors, bodily fluids, and infectious disease and frequent exposure to dust, fumes, airborne particles and/or allergens. Situations occur where PPE (personal protective equipment) is needed. Noise level is moderate to excessive. Occasional overnight travel, evening and/or weekend work will be required.