Compliance Coordinator

Step Up•San Bernardino, CA

4d•$25 - $26•Onsite

About The Position

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.

Requirements

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.
Experience in healthcare, behavioral health, social services, housing programs, or a related setting involving quality assurance, referrals, authorizations, documentation review, or reporting.
Strong computer skills with knowledge of Microsoft Office and intermediate MS Excel skills are required.
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.

Nice To Haves

Bachelor's degree preferred.
Knowledge of medi-cal billing/claims/encounters a plus.

Responsibilities

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.
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.
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.
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.