Impact Lives, Impact Community

Family Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community advocate over 50 years ago in Barrio Logan, FHCSD has grown into one of the largest community health systems in the country. With over 62 sites, over 227,000 patients, and over 417,000 visits last year, we provide a wide variety of health care and outreach services to a very diverse patient population. We are proud of our mission, our lasting community impact, and the cultural and individual diversity of our staff.

General Job Description

The Compliance Specialistis responsible for ensuring compliance with federal (CMS) and state (DHCS) regulations for the FHCSD PACE program. Duties include performing compliance risk assessments, conducting periodic audits, coordinating with others on the completion of action items and reports tasked to the program by federal and state regulatory bodies. Performs training of staff on policies and procedures, and adherence with federal and state regulations.

Essential Functions of the Job

• Monitors regulatory communications from CMS, DHCS, and other regulatory agencies. Participates in conference calls and training webinars from regulators and/or associations. Reviews, analyzes, and interprets changes and/or updates to regulatory requirements to assess its impact to PACE operations and reporting. Develops, communicates and disseminates guidance to internal departments, provides consultation, and tracks implementation and appropriate training.
• Performs compliance risk assessments to ensure that FHCSD PACE is compliant with CMS, DHCS, and other related regulatory requirements.
• Performing recurring audits of claims/invoices, such as claims/invoices received from the home care/ home health staffing agencies.
• Provide compliance training to PACE staff as needed regarding areas of non-compliance and areas of compliance focus.
• Continuously, review HPMS, CMS, DHCS regulations, and other communications, and guidelines, to determine if the regulations, communication and/or guidelines apply to FHCSD PACE, and ensure follow-up, and that any and all applicable actions items stemming from the aforementioned are assessed, and completed on time, as necessary.
• Audit documents required for each enrollment in the PACE program to ensure that all documentation is completed correctly, signed and loaded into the Smartsheets.
• Creates and monitors an annual, master calendar of compliance items that are required and reportable to various regulatory bodies for the FHCSD PACE organization.
• Work with various FHCSD PACE staff to ensure that each of the items related to compliance are being managed and completed on time, by each of the staff members, who is responsible for handling a specific compliance item
• Institute measures that prevent, detect and correct fraud, waste and abuse (FWA); Self-evaluations and internal audits and ongoing compliance monitoring system for promptly responding to compliance and FWA issues as they become known, and with a system for self-reporting compliance violations to CMS and other pertinent agencies as appropriate and applicable.
• Institute regular, internal audit cycles and work with the FHCSD PACE IDT to ensure compliance on CMS and DHCS regulations.
• Develop audit reports for FHCSD leadership.
• Work with FHCSD PACE Quality Improvement to identify risks and develop solutions for potential deficiencies
• Assist FHCSD PACE organization with coordinating CMS, DHCS surveys/audits, and other audits as necessary and applicable.
• Ensure that FHCSD PACE EHR and PACE Dashboard documentation is appropriate and complete and meets CMS/DHS standards and other applicable requirements. This will also require regular audits and staff training.
• Performs other duties as needed and assigned

Education/Certifications/Licenses/Registrations

• Bachelor's Degree in business or healthcare related degreed program or equivalent, verifiable, professional work experience.
• Medical Terminology Course required or equivalent and a combination of education and experience that provides the skills, knowledge and ability to perform the essential job duties, and which meets any required state or federal certification requirements.

Experience/Specialized Skills (including Language)

• At least two to three (2 to 3) years' experience in a health care setting or similar setting is required
• Ability to maintain good interpersonal interactions with clients, co-workers and external entities (e.g. providers, regulatory bodies etc.) as a member of a multi-disciplinary community health team with a diverse multi-cultural population.
• Ability to multi-task, be flexible, ensure accuracy, and meet changing priorities in a fast-paced, high-workload environment.
• Skilled in using Microsoft Excel and Word, and other Office software
• Excellent organizational skills, attention to detail, time-management skills, and strong motivation to meet deadlines and achieve goals.
• Clinical knowledge of medical terminology, medical procedures, diagnosis codes, CPT and HCPCS codes, and ICD-10 codes.
• Excellent verbal and written communication skills.

Physical Requirements/Working Environment

Bending (neck): RARELY (0-1 HRS)

Bending (waist): NEVER

Carrying 0 - 10 lbs: FREQUENTLY (3 - 6 HRS)

Carrying 11 - 25 lbs: NEVER

Carrying 25 - 50 lbs: NEVER

Carrying 51 - 75 lbs: NEVER

Carrying 75 lbs: NEVER

Climbing (ladder): NEVER

Climbing (stairs): RARELY (0-1 HRS)

Driving: To drive from one clinic or another, or in the community: This Individual may drive occasionally between PACE locations and sometimes to service providers, vendors etc.

Exposure to blood borne pathogens and biohazards: NO

Exposure to dust, gas, fumes, or chemicals: Office supplies.

Fine manipulation: FREQUENTLY (3 - 6 HRS)

Kneeling: NEVER

Lifting 0 - 10 lbs: FREQUENTLY (3 - 6 HRS)

Lifting 11 - 25 lbs: NEVER

Lifting 25 - 50 lbs: NEVER

Lifting 51 - 75 lbs: NEVER

Lifting over 75 lbs: NEVER

Power Grasping: NEVER

Pulling 0 - 10 lbs: FREQUENTLY (3 - 6 HRS)

Pulling 11 - 25 lbs: NEVER

Pulling 25 - 50 lbs: NEVER

Pulling 51 - 75 lbs: NEVER

Pulling over 75 lbs: NEVER

Pushing 0 - 10 lbs: FREQUENTLY (3 - 6 HRS)

Pushing 11 - 25 lbs: NEVER

Pushing 25 - 50 lbs: NEVER

Pushing 51 - 75 lbs: NEVER

Pushing over 75 lbs: NEVER

Reaching (above shoulder level): NEVER

Reaching (below shoulder level): RARELY (0-1 HRS)

Repetitive use of hand: CONSTANTLY (6+ HRS)

Simple Grasping: FREQUENTLY (3 - 6 HRS)

Sitting: CONSTANTLY (6+ HRS)

Standing: RARELY (0-1 HRS)

Twisting: NEVER

Use of Personal Protective Equipment: NO

Walking: RARELY (0-1 HRS)

Working around equipment and machinery: Office equipment

Ages of Patients Served: N/A

In the spirit of pay transparency, we are excited to share the base range for this position, exclusive of fringe benefits or potential bonuses.

If you are hired at Family Health Centers of San Diego, your final base salary compensation will be determined based on factors such as geographic location, jurisdictional requirements, skills, education, and/or experience. In addition to these factors - we believe in the importance of pay equity and consider internal equity of our current team members as a part of any final offer. Please keep in mind that the range mentioned above is what we reasonably expect to pay for the role. Hiring at the maximum of the range would not be typical in order to allow for future and continued salary growth. We also offer a generous compensation and benefits package (more information on our benefits offerings is available here: FHCSD Wellness - Employee Hub (gobenefits.net)