Compliance Coordinator

JOB TITLE: Compliance Coordinator

REPORTS TO : Director of Community Supports

HOURS: 40

CLASSIFICATION: Non-exempt

SUMMARY: Community Supports-ILOS is funded through California Advancing and Innovating Medi-Cal (CalAIM) and is a program that coordinates care by utilizing a person-centered approach to maximizing individuals’ health and life trajectory. Community Supports-ILOS services are medically appropriate and cost-effective alternatives to services covered under the state plan. All Community Supports members must be enrolled in a Managed Care program such as Inland Empire Health Plan (IEHP) or Molina Healthcare. Step Up is a contracted provider of In Lieu of Services (ILOS) – Community Supports, and Managed Care Plans refer qualified members directly to Step Up’s CS-ILOS Programs. Step Up provides services intended to improve members’ housing stability, health outcomes, and social determinants of health. CS-ILOS services consist of a care team providing in-person care management and care coordination aimed at identifying and managing comprehensive needs through improved housing stability, health outcomes, and community integration. The Compliance Coordinator supports program quality by reviewing records, reconciling reports, monitoring referrals and authorizations, and tracking corrections through completion. This position identifies patterns in documentation gaps and health plan denials, provides focused staff training, and prepares reliable information for managers and the Director. The role includes designated duties related to referrals, records, and trackers.

Benefits and What We Offer:

• Opportunities for growth and professional development.
• Generous paid time off (13 paid holidays, 10 days of EPTO, 12 sick days).
• Competitive salary and benefits package. Health, dental, vision, Aflac, and life insurance $25,000.00
• 403(b) retirement plan available on the first day of work. After working 1000 hours, Step Up matches 3% of the 6% the employee contributes.

DUTIES: The following reflects essential functions for this job but does not restrict other tasks, which may be assigned: Under the supervision of the Program Manager and director, The Compliance Coordinator I is responsible for working effectively as part of the Community Supports program to support accurate documentation, timely referrals and extension submissions, and compliance with program and health plan requirements. The Compliance Coordinator will spot check member charts, review staff notes, create and run reports, and track referral and authorization outcomes. This position will identify trends in documentation gaps, approvals, and denials; provide staff training based on those findings; and work with program leadership to resolve outstanding issues.

Compliance Review Quality Assurance

• Spot check member charts for required documents, signatures, authorization dates, service alignment, and timely completion of notes and forms. Record findings and track corrections through closure.
• Review Service Coordinator notes against program documentation standards, including the required 72-hour turnaround. Provide clear feedback on missing or inconsistent elements and refer concerns requiring clinical judgment to a qualified supervisor.
• Identify repeat errors by staff, team, service type, or workflow; report material or unresolved findings to the Program Managers and Director.
• Support internal audits and managed care plan readiness reviews by organizing chart-check results, evidence of corrections, and current workflow records.
• Maintain privacy and security of protected health information in accordance with Step Up policies and required training.

Reports Authorization and Referral Follow Up

• Create, run, and reconcile Welligent reports, including reports for overdue documentation, activity, and missing signatures, with the Master List and other source records.
• Compare IEHP and Molina authorization and referral statuses with Welligent assignments and program trackers. Investigate mismatches and notify the responsible manager or coordinator.
• Monitor authorization expiration dates and extension requests. Track when an extension is due, prepared, submitted, pending, approved, denied, or expired; follow up on missing member engagement, forms, or health plan requests.
• Submit designated Community Supports referrals through approved channels after verifying required forms and information. Follow each referral through decision and assignment.
• Maintain approval and denial trackers by health plan, service, submission date, decision date, reason, and next action. Summarize denial trends and recommend corrections to prevent recurrence.
• Flag urgent items that may interrupt member services, delay assignment, or prevent billing, and provide a clear owner and deadline for follow up.

Training and Program Support

• Create practical refresher training, reference guides, and individual or team coaching based on trends from chart reviews, report results, and denial reasons. Check whether performance improves after training. • Coordinate and participate in required trainings with other Step Up programs
• Assist with the development of training content, materials, and resources.
• Maintain clear program trackers and provide routine summaries to leadership showing completed work, outstanding corrections, authorization outcomes, and higher-priority follow ups.
• Coordinate with Intake Coordinators, Service Coordinators, Program Managers, and program support staff to resolve referral, authorization, documentation, and member assignment discrepancies.
• Participate in staff meetings, trainings, audits, and other program activities as assigned. Model Step Up core values and maintain respectful working relationships.

Documentation and Data Collection

• Maintain accurate, up-to-date logs of chart checks, corrective actions, referrals, extension submissions, decisions, and training completion.
• Prepare counts and trend summaries using consistent definitions and verify that reported data agrees with Welligent, health plan portals, and approved program trackers.
• Handle all member and staff information in approved systems and share findings only with authorized personnel.

SKILLS: Strong organization, attention to detail, and time management. Ability to review documentation consistently, interpret reports, reconcile different data sources, and communicate findings without blame. Proficiency in Excel and Microsoft Office; experience with electronic health records and managed care plan portals. Ability to develop useful training from recurring errors, manage multiple deadlines, and maintain confidential records. Familiarity with traumainformed, person-centered, and culturally responsive service practices.

QUALIFICATIONS: Experience in healthcare, behavioral health, social services, housing programs, or a related setting involving quality assurance, referrals, authorizations, documentation review, or reporting. Bachelor's degree preferred. Knowledge of medi-cal billing/claims/encounters a plus. Strong computer skills with knowledge of Microsoft Office and intermediate MS Excel skills are required. In-office; Prolonged period of sitting at a desk. Must own a vehicle, have a clean driving record and current California's driver's license and insurance. Pre-Hire Live Scan and driving background check required.

SUPPLEMENTAL INFORMATION: The position may review records concerning members experiencing homelessness, mental health symptoms, substance use, or other sensitive circumstances. Training and support are provided to help staff review these records respectfully and maintain confidentiality. Field travel, if any, and related license or insurance requirements should be determined based on the final assignment.

PHYSICAL REQUIREMENTS: While performing the duties of this job,the employee is regularly required to sit; use hands and fingers; handle or feel; reach with hands and arms; talk; and hear. The employee is frequently required to walk, balance, stoop, kneel, and/or crouch. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus. Keyboard data entry required. Step Up utilizes the principles of trauma-informed care and mental health recovery. These principles inform our Core Values of Hope, Wellness, Voice and Choice, Respect, and Collaborative Relationships. As representatives of Step Up, employees agree to adhere to these values in their interactions with members, colleagues, supervisors, and associated community members.

Disclaimer: Work with the homeless population whether on the streets, in shelters or other places of habitation or services, may present inherent challenges and difficulties such as: exposure to bed bugs or other infestations, unpleasant smells or odors, unclean individuals or homes due to homelessness or mental health symptoms or poverty. While Step Up as an agency strives to protect all employees from adverse events, Step Up is not responsible for rectifying the outcome of such exposures and considers this the nature of the environment and Workplace. Step Up utilizes the principles of trauma-informed care and mental health recovery. These principles inform our Core Values of Hope, Wellness, Voice and Choice, Respect, and Collaborative Relationships. As representatives of Step Up, employees agree to adhere to these values in their interactions with members, colleagues, supervisors, and associated community members.

STEP UP CORE VALUES

HOPE – We believe all people have the capacity for positive growth and change. We use hope to inspire and motivate ourselves, our members, our colleagues, and our community.

WELLNESS – We believe in promoting a culture that supports healthy and fulfilling lives. We use a supportive environment to support well-being for ourselves, our members, our colleagues, and our community.

VOICE AND CHOICE – We believe in the right to choose and be heard. We use voice and choice to create meaningful outcomes and empowerment for ourselves, our members, our colleagues, and our community.

RESPECT – We believe in promoting interactions that are non-judgmental and transparent. We use respect to guide our words and actions.

COLLABORATIVE RELATIONSHIPS – We believe in forming partnerships to share resources, knowledge, and experiences. We use collaborative relationships to strengthen accomplishments.

Step Up provides equal employment opportunities without regard to any characteristic protected by applicable federal, state, or local law.

STEP UP IS AN EQUAL OPPORTUNITY EMPLOYER