Ethics Specialist II

Ethics Specialist II

Remote

We offer competitive salaries, full benefits package, Paid Time Off, and opportunities for professional growth.

Pinnacle Treatment Centers is a growing leader in addiction treatment services. We provide care across the nation touching the lives of more than 30,000 patients daily.

Our mission is to remove all barriers to recovery and transform individuals, families, and communities with treatment that works.

Our employees believe we are creating a better world where lives and communities are made whole again through comprehensive treatment.

As an Ethics Specialist II, you will lead investigations of compliance concerns, allegations, and potential violations across the organization, from intake to closure. The role reviews clinical, billing, and telehealth records to determine whether services were provided and documented as billed, documents findings and root causes, and recommends corrective action. You will partner with Compliance Leadership, Human Resources, and Legal, and support payer
audits and corrective action plans as needed.

Benefits:

• 18 days PTO (Paid Time Off)
• 401k with company match
• Company sponsored ongoing training and certification opportunities.
• Full comprehensive benefits package including medical, dental, vision, short term disability, long term disability and accident insurance.
• Discounted tuition and scholarships through Capella University

Requirements:

• Bachelor's degree in behavioral health, healthcare administration, criminal justice, or a related field
• Three (3) or more years of experience conducting investigations,
  compliance reviews, or audits, preferably in a healthcare or behavioral health setting.
• OR associate's degree in a related field and five (5) or more years of investigations, compliance, or audit experience, preferably in healthcare.
• Must possess a current valid driver’s license in good standing in state of employment and be insured by a designated carrier. This role is required to drive for company purposes.
  • Travel up to 25% and overnight travel may be required

Preferred:

• Active clinical license (e.g., LMFT, LCSW, LPC, RN) or prior clinical experience in behavioral health or substance use disorder treatment
• Experience with clinical, workplace, or healthcare fraud investigations, and with compliance tracking systems
• Certification as Certified in Healthcare Compliance (CHC) or Certified Fraud Examiner (CFE)

Responsibilities:

• Conducts investigations of compliance concerns, allegations, and potential violations from intake to closure, including planning, evidence gathering, interviews, analysis, and written findings.
• Conducts investigations involving teammates and leaders, notifying human resources at intake when a matter has potential employment implications and partnering with HR on interviews and corrective action as appropriate, while maintaining Compliance’s independence over investigation findings. Escalates allegations involving senior
  leadership to Legal and Compliance leadership per policy.
• Reviews clinical and billing records, electronic health records, telehealth session data, video footage, and other evidence to evaluate whether services were provided and documented as billed.
• Preserves evidence and maintains complete, confidential, and timely investigation files, including a documented outcome for every case.
• Applies the Billing Auditor Escalation Guideline and related protocols when audits or reviews suggest falsification, cloned documentation, services not rendered, or other potential violations.
• Prepares clear investigation reports with findings, root causes, and recommended corrective actions for Compliance leadership, Human Resources, and Legal.
• Coordinates with Human Resources on employment actions, and with Legal on matters that may require privileged handling, regulatory or licensing board reporting, or repayment.
• Supports payer audits, prepayment and post-payment reviews, and corrective action plans required by payers, counties, or regulators.
• Conducts targeted billing and documentation audits to support investigations or to assess whether an issue extends beyond a single case.
• Manages assigned disclosure program (hotline) cases in the reporting system, ensuring accurate intake, tracking, and closure.
• Monitors the implementation and effectiveness of corrective actions resulting from investigations and audits.
• Tracks, analyzes, and reports investigation trends and outcomes, and supports monthly and quarterly disclosure program reporting.
• Responds to compliance-related inquiries from employees, leadership, and external stakeholders.
• Assists with developing and delivering training on documentation, professional boundaries, and other topics identified through investigations.
• Provide guidance and oversight on organizational ethics matters, including interpretation and application of the Code of Conduct, review and management of conflict-of-interest disclosures, assessment of gifts and business courtesies, administration of ethics-related training and awareness initiatives, and investigation and resolution of ethical concerns to promote compliance with organizational standards and regulatory requirements.
• Stays current on federal, state, and local regulations, payer requirements, and best practices that affect investigations and compliance.
• Performs other duties as assigned.

Join our team. Join our mission.