COMPLIANCE & AUDIT COORDINATOR

SUMMARY OF POSITION:

The Compliance & Audit Coordinator is responsible for supporting the ongoing execution and improvement of the NEMS PACE Compliance Oversight Program to ensure regulatory compliance with the PACE program requirements. The Compliance & Audit Coordinator will monitor, analyze, and synthesize action plans based on regulatory guidance from applicable regulators, which include but are not limited to CMS, DHCS, CDPH, PACE, etc.

ESSENTIAL JOB FUNCTIONS:

• Conducts regular internal auditing and monitoring to identify gaps in compliance and ensure compliance with applicable PACE program and PART D program requirements. Maintains clear and concise documentation of completed audits in preparation for external audits by regulators.
• Monitors contracted vendor compliance with contract and program requirements. Identifies deficiencies and escalates to supervisor for resolution.
• Monitors CMS HPMS website for participant complaints through the Compliance Tracking Module (CTM). Notifies supervisor and PACE program management of complaints and assists with posting responses to CMS via the HPMS portal.
• Monitors and completes required submissions to the CMS HPMS website. Submissions include, but are not limited to quarterly fraud, waste and abuse (FWA) reporting and marketing material submissions.
• Assists in reviewing notifications from regulators (DHCS/CMS, etc.), interpreting regulatory requirements and changes related to the NEMS PACE program and responds as needed.
• Conducts regulatory research on a broad range of subjects and interprets requirements and guidelines to ensure NEMS PACE meets compliance with legal and regulatory requirements.
• Supports regulatory audits by external regulators such as CMS and DHCS and report results to organizational leaders and executives.
• Coordinates corrective action plans (CAP) from external audits and coordinate and submit responses to meet regulatory deadlines.
• Documents regulatory changes, create/implement project plans to meet regulatory compliance, and remain aware of industry changes and/or trends.
• Coordinates project plans and ensure time-sensitive deadlines are met in accordance with regulatory guidelines.
• Supports NEMS Corporate Risk Management, Privacy & Compliance Officer in updating and enforcing NEMS Corporate Compliance Program.
• Collaborates with other functional areas in investigating potential compliance issues.
• Assists with policy and procedure draft and revision to meet compliance with program requirements.
• Participates and attends relevant NEMS meetings and/or joins appropriate committees and workgroups including, but not limited to the PACE Fraud, Waste and Abuse (FWA) Workgroup, and PACE Compliance Oversight meetings. Takes and maintains meeting minutes from workgroup meetings.
• Establishes and maintains effective interpersonal relationships with all levels of staff, other programs, agencies, members, providers, and the general public.
• Prepares and maintains concise and clear reports.
• Identifies pertinent policy issues; develops strategies, solutions, and procedures.
• Performs other job duties as required by manager/supervisor.

QUALIFICATIONS:

• Completion of a Bachelor's degree from an accredited institution or minimum four years' experience in political science, legal studies, regulatory/compliance, English, business administration, public health, or related field required.
• Minimum one to two years' experience working in healthcare and/or healthcare administration field, managed care preferred.
• Experience in compliance, auditing, quality assurance, and research is preferred.
• PACE experience preferred.
• CPHQ or CHC certification preferred.
• Experience and familiarity with EPIC medical records.
• Knowledge of Medicare and Medi-Cal benefits and regulations is a plus.
• Extremely detail oriented and organized, ability to identify deficiencies and provide solutions, excellent problem-solving and critical thinking skills required.
• Ability to multi-task and manage multiple projects to meet hard deadlines.
• Able to utilize appropriate software and interact as needed with NEMS PACE Information Systems.
• Advanced proficiency in Microsoft Office Suite, including Word, Excel, and Power Point is a plus.
• Intermediate proficiency in Microsoft SharePoint and/or other internet programs is a plus.
• Able to work independently and as an effective member of a team.
• Communicates effectively, both verbally and in writing, with individuals from varying cultural backgrounds.

LANGUAGE:

• Must be able to fluently speak, read and write English.
• Fluency in other languages are an asset.

STATUS:

This is an FLSA non-exempt position.

This is not an OSHA high-risk position.