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Neighborhood Healthcare · 15 hours ago

PACE Compliance Specialist

Murrieta, CA

Full-time

Onsite

Entry, Mid Level

$32.40/hr - $45.38/hr

2+ years exp

Neighborhood Healthcare is a community health organization focused on providing comprehensive care to seniors. The Compliance Specialist role is crucial for maintaining compliance systems and processes, conducting audits, and ensuring adherence to regulations and internal policies within the PACE program.

Health Care

Responsibilities

Maintain, refine, and operationalize audit tools to ensure full readiness for CMS and DHCS reviews

Conduct internal audits of participant records to validate completeness, timeliness, and compliance with documentation standards

Coordinate and prepare audit universes, supporting documentation, and file validation for CMS, HPMS, and DHCS audits

Manage audits and reporting related to CMS and HPMS requirements, including internal mock audits and monitoring deliverables

In collaboration with the Quality Analyst, review grievance, appeal, and service determination request (SDR) records for timeliness, resolution, and documentation accuracy

Ensure compliance policies and procedures are consistently understood and applied across departments and sites

Identify and escalate compliance issues, patterns, or risk areas to the PACE Compliance Officer for timely resolution

Draft and support corrective action plans, track resolution progress, and monitor the effectiveness of implemented actions

Prepare concise, actionable reports and presentations that summarize audit findings and compliance status for leadership

Support and document root cause analyses, and assess the sustainability of corrective actions

Assist in drafting, reviewing, and updating policies, procedures, and standard operating procedures (SOPs)

Support CMS audits, HPMS reporting, and internal compliance procedures, contributing to subject matter expertise in these areas

Validate data sets used in CMS/state audits, I-SAT, and HOS-M reporting, ensuring accuracy and completeness

Coordinate pre-survey activities and documentation for state and federal audits in collaboration with internal stakeholders

Facilitate compliance-related training and refresher sessions for staff, departments, and contractors

Maintain confidentiality of participant, team member, and company information at all times

Attend required staff meetings, training sessions, and cross-functional briefings

Maintain ongoing communication with supervisor and team to align on goals, audit priorities, and deadlines

Ensure timely completion of all compliance, health, and safety-related training assignments

Support flexible scheduling needs, including occasional evening or weekend assignments based on audit demands

Perform additional compliance-related duties as assigned

Qualification

Healthcare complianceAuditing experienceEMR systemsBLS certificationHealthcare regulationsData analysisCommunicationOrganizational skillsAttention to detailAdaptabilityTeam collaboration

Required

Bachelor's degree in healthcare administration, public health, business, or related field required or equivalent experience in lieu of a bachelor's degree required

A minimum of 2 years of relevant healthcare compliance or auditing experience required

Demonstrated experience conducting audits, preferably in a healthcare setting required

Experience working with EMR systems and validating data accuracy required

Current Basic Life Support (BLS) certification is required upon hire and must be maintained as a condition of employment. These courses must follow AHA guidelines, but may be completed through approved online providers such as ProMed or other equivalent programs that meet recognized BLS standards

Strong understanding of healthcare regulations, including HIPAA and PACE program requirements

Proficient in reviewing clinical documentation and interpreting EHRs

Familiarity with interdisciplinary team functions and care planning workflows

Comfortable using structured audit tools and applying objective scoring standards

Ability to identify patterns in audit findings and communicate themes to leadership

Strong written communication skills with the ability to summarize complex findings clearly

Self-directed with strong organizational and time management skills

Highly analytical with strong attention to detail and accuracy

Quick learner with the ability to adapt to evolving processes and regulatory updates

Ability to manage multiple priorities in a dynamic environment