Job Summary:

With strong attention to detail and developed knowledge of regulatory requirements, the Compliance Associate creates structures and facilitates processes which support the delivery of high-quality care for PACE participants. The Compliance Associate collaborates with the Interdisciplinary Teams (IDT) and department managers to ensure staff have knowledge of the regulatory processes they must uphold. Through regular chart audits and data review, the Compliance Associate assesses organizational compliance and readiness for state and federal surveys. 

Under the supervision of the Compliance Manager, the Compliance Associate supports the organization’s adherence to regulatory guidelines through education, provision of information, and auditing. Areas of regulatory oversight provided by this role include the care planning process, documentation of participant assessments, communication, and other activities; service delivery, and provision of services, to name a few. 

Duties/Responsibilities:

Regulations And Policy

• Serves as an internal subject matter expert on all regulations and laws governing PACE operations; remains current with changes in regulations.
• Demonstrates knowledge and understanding of all key regulatory statutes that impact PACE-RI as well as internal policies and procedures that relate to the IDT and provision of services.
• Updates and improves existing policies and procedures as needed or directed.
• Assists in the development of new policies, procedures, and workflow changes due to new rules, legal requirements, etc. 
• Collaborates to ensure compliance requirements are met related to care plans, assessments, SDRs, grievances, RCA event reporting, etc.
• Monitors compliance with SDRs, ensures approved services are provided, and all documentation is complete and accurate.

Monitoring, Audits, & Survey Readiness

• Performs audits of participant charts and sites to ensure compliance with PACE metrics, CMS and DOH regulations. 
• Attends daily Team meetings to monitor regulatory compliance and provide policy and procedural support; serves as primary compliance resource for the Teams. 
• Produces CMS Universes as directed and when required by CMS, ensures thoroughness and accuracy.
• Contributes to the development and maintenance of an organizational audit-readiness plan in anticipation of the CMS Survey.
• Actively supports and reinforces the organization’s “Always Ready” approach to CMS surveys and other regulatory audits.
• Assists in the development of corrective action plans with teams and managers in a collaborative way. 

Performance Management

• Serves as project manager for compliance improvement related projects for all areas.
• Collaborates with interdisciplinary teams to foster a culture of accountability and continuous improvement. 
• Identifies compliance and quality issues that emerge in team and care plan meetings and advises IDT members on necessary action steps.

Education, Training, & Team Support

• Educates and trains staff on regulatory requirements as related to participant documentation and provision of services.
• Provides feedback to staff on results of internal audits, identifying areas where improvement is needed.
• Is an active member of Risk Management, Quality Committee, and other committees as delegated.
• Supports investigations into compliance and quality related allegations.
• Serves as a backup to the Compliance Manager in monitoring and responding to issues reported through the Compliance Hotline.

General Resonsibilities

• Demonstrates initiative by proactively identifying issues, proposing solutions, and taking appropriate action.
• Tracks and monitors complex multi‑step processes across departments.
• Continuously develops and maintains expertise in regulatory requirements, compliance standards, and organizational policies and procedures.
• Demonstrates proficient use of electronic health record. 
• Performs other related duties as required and assigned.

Required Skills & Abilities: 
Exceptional organizational, analytical, and communication skills
Strong attention to detail and ability to prioritize tasks
Proficiency with MS Office Suite, proficiency with Excel, ability to produce graphs and data driven reports
Experience working with federal and/or state regulations and healthcare compliance standards, preferred
Ability to maintain confidentiality
Ability to maintain sound judgement under stress 
Dependable and punctual with ability to maintain consistent attendance 
Ability to read, write and comprehend English 

Education Requirements:
Bachelor's Degree, Required

Physical Requirements:
Must be able to tolerate prolonged periods sitting at a desk and working on a computer.
Must be able to lift up to 10 pounds and at times up to 20 pounds.
Must be able to navigate various departments of the organization's physical premises as well as related community care settings.
Must be able to tolerate conditions typically associated within a medical office and/or home care setting including potential exposure to bloodborne pathogens and infectious diseases. 

Experience:
1 to 3 years of healthcare compliance experience, Preferred 
1 to 3 years of EMR Experience, Preferred 
1 year of experience working with a frail or elderly population, Preferred 

License & Certification Requirements:
Certification in Health Care Compliance (HCCA) preferred

Position Requirements:
Driver's License & access to reliable transportation: community-based travel required.