EPSDT/Compliance Administrator (Albuquerque, NM)

THE ROLE:

Are you looking for a rewarding career where you can make a difference in people's lives? The EPSDT/Compliance Administrator is a leadership and operational role responsible for the administration, compliance oversight, and coordination of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Personal Care Services (PCS) in accordance with New Mexico Medicaid (Turquoise Care) requirements. This position ensures compliance with New Mexico Human Services Department (HSD), Medical Assistance Division (MAD), and Healthcare Authority (HCA) regulations.

Pay Rate: $21.00/hour - $22.00/hour

Hours: Monday - Friday, 8:00AM - 4:00PM

Responsibilities:

• Manage EPSDT referral intake, tracking, and service initiation.


• Coordinate new member onboarding, ensuring eligibility verification, service authorizations, and required RN assessments.


• Schedule and maintain RN supervisory and reassessment visits per NM EPSDT timelines.


• Maintain accurate EPSDT member records in compliance with MAD and DOH standards.


• Compliance Program Management


• Develop and maintain compliance policies, procedures, and work instructions aligned with NM Medicaid regulations.


• Ensure compliance with DOH, HCA/MAD, and federal Medicaid requirements.


• Conduct internal compliance audits and maintain audit readiness.


• Regulatory Knowledge & Monitoring
  
  
  
  • Interpret NM Administrative Code (NMAC) and Turquoise Care EPSDT policies.
  
  
  • Monitor regulatory updates and implement required operational changes.
  
  
  
  


• Staffing, Supervision & Workforce Management
  
  
  
  • Onboard Personal Care Assistants (PCAs).
  
  
  • Maintain PCA schedules to meet authorized service plans.
  
  
  • Conduct PCA trainings, evaluations, and competency validations.
  
  
  • Validate timesheets/mileage and maintain personnel records for EPSDT PRN RN’s
  
  
  • Ensure timely renewals and compliance for all employees.
  
  
  
  


• Auditing, Investigations & Incident Management
  
  
  
  • Receive, document, and investigate all incidents.
  
  
  • Conduct internal investigations and corrective action plans.
  
  
  • Report findings to the VPO and CEO.
  
  
  
  


• Training & Education
  
  
  
  • Educate staff on EPSDT policies, compliance, and NM regulatory requirements.
  
  
  • Maintain documentation of all required trainings.
  
  
  
  


• Recordkeeping & Reporting
  
  
  
  • Maintain accurate compliance, personnel, and EPSDT records.
  
  
  • Produce internal and external reports as required.
  
  
  
  


• Marketing & Communications
  
  
  
  • Assist with marketing initiatives and community outreach.
  
  
  
  

Requirements:

• High school diploma or equivalent; Associate’s or bachelor’s degree in healthcare administration or related field preferred.


• Experience with NM Medicaid/EPSDT or PCS services preferred.


• Proficiency in MS Office (Word, Excel, PowerPoint) and other relevant software


• Strong knowledge of compliance, audits, and healthcare operations.


• EMR/LMS software experience preferred


• Strong communication skills, both written and verbal


• Excellent organizational skills and attention to detail


• Ability to multitask and prioritize tasks effectively


• A friendly disposition and ability to work well with diverse groups of people


• Bilingual (English/Spanish) preferred


• Current CPR certification is required for this position and must be maintained throughout employment in accordance with agency policy, New Mexico Healthcare Authority (HCA), and Medicaid/EPSDT requirements.

Physical Requirements:

• Must be able to talk, listen, and speak clearly on the telephone.


• While performing the duties of the job, employee is required to stand, walk, stoop, bend, sit for long periods of time; and must be able to read, write, speak, and hear well enough to communicate. Manual dexterity is required to utilize keyboards and office equipment. Employee may occasionally be required to lift up to 20lbs to file documents, and/or store office material. Reasonable accommodation will be made to accommodate individuals with disabilities that can perform essential job functions.


• Push and pull 50 pounds (move equipment, etc.)


• Carry equipment/supplies


• Use upper body strength


• Squeeze with hands (operate fire extinguisher)


• Twist


• Bend


• Stoop/squat


• Move quickly (respond to emergencies)


• Climb stairs


• Walk


• Stand

Additional Notes:

• Travel will be required for in-person visits, events, conferences, company meetings, team days to the office, or as required by the Manager.


• Will work with challenging clients.


• Adheres to Standards of Excellence


• On occasion, employee may work after hours and/or weekends

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