PACE Compliance Specialist

Overview

The Compliance Specialist supports the design, implementation, and daily operations of the compliance program for Neighborhood Healthcare PACE. This role is responsible for maintaining compliance systems and processes that ensure adherence to applicable laws, regulations, and internal policies. The Compliance Specialist conducts audits, analyzes data for trends, supports training efforts, and contributes to the development of a culture of compliance and accountability across the organization.

This position supports multiple PACE sites, including existing locations and new sites as the program continues to expand.

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

• Bachelor s degree in healthcare administration, public health, business, or related field required. 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
• Experience in early-stage or startup environments preferred

• 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
• Familiarity with the PACE model is strongly preferred

Neighborhood Healthcare offers a generous benefit plan that includes partially company-paid Medical, Dental, and Vision Plans, two-plus weeks of vacation, nine holidays including two floating holidays, Sick/Personal time, Volunteer Time Off (VTO), 403b Retirement plan, optional Health and Wellness events, and more.

Pay range: $32.40-$45.38/hr, depending on experience, education and additional qualifications.

Compensation Disclosure:
The posted salary range reflects the designated pay grade for this position. Actual compensation will be based on factors including, but not limited to, the candidate’s knowledge, skills, experience, market data, internal equity, and…