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.

Job Summary
The FHCSD PACE Compliance Manager is responsible for ensuring compliance with all federal (CMS) and state (DHCS) regulations, and other regulations and standards as necessary and applicable for/to the FHCSD PACE program. Develop and build out the compliance program for the FHCSD Program for All Inclusive Care for the Elderly (PACE).

Job Description

Develop and build out the compliance program for the FHCSD Program for All Inclusive Care for the Elderly (PACE). The FHCSD PACE Compliance Manager is responsible for ensuring compliance with all federal (CMS) and state (DHCS) regulations, and other regulations and standards as necessary and applicable for/to the FHCSD PACE program. Duties include, but not limited to, performing compliance risk assessments and analysis, conducting periodic audits, coordinating with others, both internally and externally, on the completion of audits 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. Ensuring, in collaboration with FHCSD Quality timely submissions to CMS (via HPMS), DHCS, and to other regulatory bodies.

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, maintains and monitors a master calendar of compliance items that are required by the FHCSD PACE organization, and are reportable to various regulatory bodies.
• 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.
• Support the FHCSD PACE organization with coordinating CMS, DHCS surveys/audits, and other audits, and the like, as necessary and applicable.
• Ensure that FHCSD PACE EHR and PACE Dashboard documentation is appropriate and complete and meets CMS/DHCS standards and other applicable requirements. This will also require regular audits and staff training.
• Performs other duties as needed and assigned.
• Ages of Patients Served: Seniors 55+

Education/Certifications/Licenses/Registrations

• Bachelor's Degree in business or healthcare related degreed program or equivalent, verifiable, professional work experience.
• 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)

• 5 years' experience in a health care setting or similar clinical setting is required.
• Previous PACE experience is highly desirable.
• 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, Word, PowerPoint and other applicable software and tools.
• Excellent organizational skills, attention to detail, time-management skills, and proven ability to meet deadlines and achieve goals.
• Advanced knowledge of medical terminology, medical procedures, diagnosis codes, CPT and HCPCS codes, HCCs, and ICD-10 codes.
• Excellent verbal and written communication skills.
• #PACE

Ages of Patients Served: Seniors 55+

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)