Resident Benefits Compliance Specialist

Job Description

Job Description

JOB DESCRIPTION
TITLE:  Resident Benefits Compliance Specialist
DEPARTMENT:  Quality Assurance
REPORTS TO:  Quality Assurance Manager
SCHEDULE:  Monday–Friday, 8:30 AM–5:00 PM  ·  travels between communities

JOB SUMMARY

The Resident Benefits Compliance Specialist protects residents’ government benefits and the company’s revenue integrity. The role manages the full Social Security, SSI/SSP, and Medi-Cal lifecycle for residents of our licensed board-and-care (RCFE) communities, and conducts on-site audits of employee and resident files to ensure regulatory compliance. The position partners with the Quality Assurance and Accounting departments to resolve benefit delays before they compromise resident benefits or company collections.

A.  DUTIES AND RESPONSIBILITIES

Resident Benefits — Social Security, SSI/SSP & Medi-Cal

• Assist residents and families in establishing and maintaining SSA, SSI/SSP, and Medi-Cal benefits before, during, and throughout residency.
• Notify the Social Security Administration when a resident moves into a licensed non-medical board-and-care facility, and ensure the resident’s aid code and SSI/SSP payment are changed to the correct Non-Medical Board and Care living-arrangement rate.
• Verify each resident has no Medi-Cal Share of Cost (SOC) issue; where a SOC exists, address it immediately — spend-down, redetermination, or documentation — so benefits are not reduced or compromised.
• Confirm Medi-Cal eligibility is active and current for every resident; track redetermination dates and prevent any lapse in coverage.
• Assist with appointing Glen Park as representative payee where appropriate, and maintain accurate payee records.
• Maintain a resident-by-resident benefits log capturing aid code, SOC status, Medi-Cal active date, and dollar value recovered or protected.

On-Site File & Compliance Auditing

• Conduct on-site audits of employee personnel files and resident files across all communities to confirm every mandated document is present, current, and compliant under Title 22, Title 17, Regional Center, Department of Labor, and Glen Park policy.
• Flag each deficiency with a corrective action and resolve-by deadline; report status to the QA Manager, Executive Directors, and President.
• Ensure facility records are audit-ready in anticipation of unannounced third-party and licensing inspections, and assist with audit-preparation activities as directed.

Cross-Department Coordination & Reporting

• Work with the QA Department and Accounting Department to identify and report delayed or non-payment of Social Security/SSI and Medi-Cal benefits, and drive resolution to protect collections.
• Attend monthly QA meetings with upper management and present benefits-recovery and compliance status.
• Review all documents for conformity with HIPAA and maintain strict confidentiality of resident and personnel records.
• Remain current on Title 22, Title 17, and regulatory changes affecting benefits and quality.
• Perform other related duties upon request.

B.  MINIMUM QUALIFICATIONS

• Two (2) or more years of experience working with Social Security, SSI/SSP, and Medi-Cal benefits — eligibility, aid codes, and Share of Cost — preferably in senior living, RCFE/board-and-care, skilled nursing, or the healthcare/insurance industry.
• Working knowledge of California Title 22 RCFE personnel and resident record requirements.
• Strong file-audit, analytical, and organizational skills with close attention to detail and accuracy.
• Background clearance through FBI and DOJ.
• Current First Aid and CPR certification.
• Valid California driver’s license and good driving record; able to travel between communities for on-site audits.
• Proficiency with Microsoft Office and Google Workspace; comfortable with CRM and EMR/EMAR systems.

C.  PREFERRED

• Familiarity with the representative-payee process, MEDS/BIC look-ups, and county Medi-Cal redetermination.
• Bilingual (English/Spanish) a plus.

D.  KEY DELIVERABLES & CADENCE

• Weekly: Weekly resident benefits status report (aid code, Share of Cost, Medi-Cal active) and on-site file-audit findings with deadlines.
• Monthly: Benefits-recovery dollar report to QA and Accounting; attend the monthly QA meeting with upper management.

PHYSICAL REQUIREMENTS

• Prolonged periods sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times; able to travel between community sites.

Other Duties: This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee. Duties, responsibilities, and activities may change at any time with or without notice.

 

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