Appeals and Compliance Specialist

Appeals and Compliance Specialist

Starting Salary: $84,495 - $101,395

This position reports to the Executive Director and is responsible for managing complaints, informal resolution meetings, mediations, and appeals, ensuring compliance with state and federal laws and regulations— as well adherence to GGRC’s contract with the Department of Developmental Services, and other requirements. In addition, the position acts as a liaison to track legislation and facilitates revisions to applicable policies, procedures and forms as needed to comply with changes in the applicable laws, regulations and contract amendments. The position is also responsible for communicating these changes to GGRC departments, staff and stakeholders, as appropriate.

Local travel within the Counties of San Francisco, San Mateo and Marin. Occasional statewide travel to sites throughout California. Access to reliable transportation permitting travel to and between many different locations throughout the day in order to perform the outlined responsibilities of the position

Responsibilities

• Lead and oversee the appeal process from submission to resolution, including informal meetings, negotiation settlement of mediations, Early Start and Lanterman Appeals and other complaints outlined on DDS’ website under Appeals & Complaints.
• Act as a primary liaison and point of contact for DDS’ Office of Community Appeals and Resolutions.
• Represent GGRC at mediation sessions and appeal hearings, ensuring effective communication and resolution.
• Prepares staff to act as witnesses for appeal hearings.
• Serves as the custodian of records for all matters related to those served and monitors/responds to HIPPA violations for Regional Center Services and Community Services.
• Adhere to legal timelines during the appeal process and participate in conference calls with Administrative Law Judges and claimants.
• Compile monthly status reports and an annual report on appeals, offering insights and recommendations.
• Analyze appeals and hearings, prepare statistical reports to identify trends and optimize agency overall effectiveness.
• Collaborate with internal departments to streamline the appeals process and improve efficiency.
• Conduct regular audits of appeal documentation and procedures to ensure accuracy and compliance.
• Provides consultation and training to staff on the requirements of the Lanterman Act, Title 17, and GGRC’s purchase of services guidelines, ensuring compliance and understanding.
• Provides consultation and training to staff on Notices of Action and the appeal process for both those served and vendors.
• Investigates and responds to W & I 4731 and whistleblower complaints within mandated timelines, maintaining accountability and transparency.
• Oversees tracking of 4731 complaints and ensures timely reporting to DDS.
• Serve in a consultation capacity for social workers and their managers on all matters related to the denial of services including reductions in services.
• Collaborate with legal counsel as needed and ensure GGRC compliance with regulations and statutes.
• Ensures accuracy of legal forms i.e. Release of Information.
• Support case management staff to help protect the rights and legal interest of those served within the requirements of what a regional center can legally provide in the form of support and services. 
• Review, advise, and ensure GGRC compliance with the regulations and statutes including all 4731 complaints and whistleblower complaints as designated by the Executive Director.
• Monitor the timely submission of regional center-specific reports required by DDS.
• Develop and maintain Memorandums of Understanding between the regional center and our community partners (i.e., foster care, mental health, school districts, healthcare plans, Disability Rights California Office of Client’s Rights, etc.).
• Establish, maintain, and promote positive interpersonal relationships with staff and members of the community, including those served, families, and staff in the community, service providers and government offices.
• Stay informed about public transparency regulations, industry best practices, internal standards, and organizational goals, providing relevant training to address common appeals issues and incorporating new knowledge into GGRC’s practices.
• Any other relevant duties as assigned by the supervisor.

Requirements

• Bachelor’s degree in social work, psychology, public or business administration, or related field. Master’s degree preferred.
• Minimum five years of experience working with developmental disabilities or related friends.
• Minimum three years of experience in a similar role with a social services agency, legal environment, or healthcare setting.
• Strong understanding of legal processes and regulations relevant to appeals, including knowledge of the Lantermant Act, Title 17 and HIPAA.
• Experience representing organizations at mediation sessions, and appeal hearings with a track record of effective communication and conflict resolution.
• Experience participating in administrative appeals.
• Previous work experience in a Regional Center a plus

Skills

• Ability to apply relevant laws, regulations, requirements, and policy standards.
• Negotiate successfully and prepare effective presentations for administrative law judges.
• Ability to interpret and apply a variety of legal requirements and policy standards.
• Ability to handle a wide variety of situations and complex issues.
• Ability to handle change well and be flexible and adaptable in dealing with interruptions, new priorities, and new assignments.
• Multi-task, work well under pressure, prioritize, and produce within deadlines.
• Ability to prepare statistical and narrative reports.
• Ability to establish and maintain effective communications and operational network.
• Ability to convey complex information and ideas to diverse groups clearly, concisely, both verbally and in writing.
• Strong organizational skills with the ability to prioritize tasks, meet deadlines, and maintain accuracy and compliance in appeal documentation and procedures.
• Excellent interpersonal skills with the ability to establish and maintain positive relationships with those served, families, staff, and community partners.
• Ability to operate basic office equipment and use software applications like MS Word, Excel, PowerPoint, and Outlook.
• Ability to operate basic office equipment, including scanners, copiers, faxes, phones.
• Self-motivated and takes initiative.
• Understands and effectively reacts/adapts to multiple and competing priorities on the job; uses knowledge and expertise to focus on key job outcomes.

Competency

• Legal Compliance
• Negotiation Skills
• Communication Proficiency
• Adaptability
• Organizational Skills
• Interpersonal Skills
• Problem solving Ability
• Teamwork and Collaboration
• Initiative and Self-Motivation
• Attention to Detail
• Ethical Conduct
• Customer Service Orientation

Desired Qualifications

• Experience in the Regional Center System

• Experience in multi-cultural settings and/or multi-lingual capacity

Benefits

What are the benefits to working with GGRC?

Generous Tuition Reimbursement Program that reimburses qualifying employees up to $10,000 per fiscal year.

We offer a comprehensive benefits package including Medical and Dental benefits with a generous employer contribution and additional employer paid Life, Disability and Vision coverage

10% employer contribution to a 403(b) retirement account to help you save for the future!

GENEROUS TIME OFF BENEFITS!!!

No really, we mean generous:

13 vacation days, 15 sick days, 10 paid holidays, 4 personal holidays, 3 winter holidays, and up to 5 paid days for continuing education

What makes GGRC so special?

GGRC values diversity, we believe in creating an environment where people of all backgrounds can collaborate to find solutions to complex problems. We are community minded and passionate.

GGRC values each person as a full, robust, and unique individual and interacts with each person in a manner that is respectful and responsive. We endeavor to place each person at the center of his, her or their own life. We approach each person as an expert on his, her or their own life and identity with a clear and attentive inquiry into what is important to, as well as important for, that one person (whether coworker or person-served, family member or other stakeholder).

How to apply:

GGRC values diversity; people of all backgrounds are encouraged to apply. Please complete the application and submit your most recent resume. If you feel that the questions do not accurately capture what you have to offer Golden Gate Regional Center, you are also welcome to attach a cover letter. Applications are being reviewed on a rolling basis so we encourage you to submit yours soon. We look forward to reading your application.

Golden Gate Regional Center is an Equal Opportunity Employer.