Quality & Compliance Coordinator

Description

The Quality & Compliance Coordinator is responsible for supporting the Quality & Compliance Director in implementing and managing the Quality Improvement (QI) Plan and Compliance Plan within the PACE organization. This role involves planning and coordinating required meetings, internal audits, data collection activities, and ensuring compliance with regulatory requirements.

Requirements

Responsibilities

Plan Implementation:

• Collaborate with the Quality & Compliance Director to implement the annual QI Plan and Compliance Plan, including Fraud, Waste, and Abuse initiatives.
• Plan and organize all required meetings, internal audits, and data collection activities.

Committee Coordination:

• Assist in scheduling and coordinating the HDP Quality Committee with the Quality & Compliance Director and Medical Director.
• Prepare meeting agendas, minutes, and assist with committee correspondence and presentation materials.

Progress Tracking:

• Track and report the progress of QI and Compliance activities.
• Ensure timely and accurate reporting to CMS, the state, and other reporting bodies.

Survey Preparation:

• Lead survey preparation projects and act as the liaison for High Desert Pace during all surveys.

Licensure Management:

• Ensure all business and clinical licensures are current and appropriately posted.

Communication:

• Effectively communicate the QI and Compliance plans to participants, staff, contractors, administration, and the participant advisory committee.
• Monitor and address HPMS complaints and memorandums, coordinating necessary actions per guidance.

Staff Engagement:

• Engage staff (direct hire and contracted) in the QI and Compliance processes through Continuous Quality Improvement education and Compliance education.
• Develop opportunities for staff input in these processes.

Audit Assistance:

• Assist the Director with audits on medical record documentation, medical and pharmacy claims, and other reports to ensure compliance.
• Maintain records and data per policies and procedures and ensure retention for the mandated period.

Grievance Resolution:

• Assist in evaluating and resolving medical and non-medical grievances, service delivery requests, and appeals by participants and/or their representatives.
• Ensure all required timelines are met and incorporate information into the development of Quality Improvement initiatives and the annual QI plan.

Education & Training

• Bachelor’s degree and/or two (2) years of PACE regulatory and executive administration assistant level experience preferred (high school diploma or equivalent required)
• A combination of education and experience may be acceptable.

Skills & Abilities

• Minimum of one (1) year of documented experience working with a frail or elderly population.
• Comprehensive to expert proficiency with Microsoft product suite (MS Word, Excel, Power Point, etc.). 
• Basic knowledge and experience with electronic mail and calendaring system. 
• Knowledge of systems necessary, experience preferred. 
• Ability to type with speed and accuracy. 
• Ability to use other software as required to perform the essential functions of the job.
• Ability to research, analyze and assimilate information from various on-site or virtual sources based on technical and experience-based knowledge. 
• Must exhibit critical thinking skills and possess the ability to prioritize workload.
• Attention to Detail. Ensures accuracy in reporting and documentation.
• Analytical Skills. Ability to analyze data and develop actionable plans.
• Problem-Solving. Identifies issues and implements effective solutions.
• Team Collaboration. Works effectively with various stakeholders.
• Regulatory Knowledge. Understands and stays updated on relevant regulations and standards.

Working Conditions

The working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Primarily work indoors.
• Usually have their own office or a shared office space
• Are exposed daily to participants who have diseases or infections.
• Wear protective clothing such as a gown, masks, and gloves, as needed.
• Work very close to others, especially when examining participants.
• While performing the duties of this job, the employee is frequently required to walk, sit, and/or stand.
• The employee must occasionally lift and/or move up to 25 pounds.