Overview

　　Full-time position starting at $26.32 - $29.28/hr (D.O.E) withCOMPETITIVE BENEFITS INCLUDE:

　　Medical, Dental, Vision, Life Insurance and Long-Term Disability

　　Health Savings Account and Flexible Spending Account

　　Generous PTO, paid sick time, 15 days of paid vacations, 13 days of paid holidays, plus a personal holiday

　　CCS/CHS 403(b) Employee Saving Plan

　　Employee assistance program

　　Program Description

　　The Foundational Community Support (FCS) program provides Supportive Housing and Supportive Employment Services under the Medicaid Transformation Project. These services are for people with complex behavioral and or physical health needs who benefit from additional support in order to be successful in finding and maintaining housing or employment. Clinicians work with individuals to build rapport and develop trust in order to assist with: housing/employment search and placement, stability planning, community resource linkages, care coordination with providers, landlord-tenant mediation or employer advocacy. This program is entirely funded through a Medicaid fee-for-service structure, and as such, there are several key performance areas related to data quality, accuracy and timeliness that must be met in order to ensure that the program receives reimbursement from the Medicaid payer to the fullest extent possible.

　　Position Description

　　The Compliance Specialist will be responsible for ensuring all program compliance in accordance with program contracts, Medicaid billing requirements, funder quality assurance guidelines, and agency protocols. This position is responsible for requesting and ensuring approval of all initial and renewal authorizations from the program payer. Authorizations are required for reimbursement of any services provided under the FCS program, which means that all program funding relies entirely on approved authorizations. This position will also be responsible for the quality and accuracy of the client records. This is achieved through the routine review of operational reports, internal file audits, coaching and guidance to clinical case managers and their supervisors, and a high degree of communication with the program funder. The Compliance Specialist is expected to work fairly independently to monitor, review and track high volumes of client related and time-sensitive data. Experience, familiarity and comfort with Microsoft Office suite products are essential in order to generate, monitor and analyze reports that inform client service delivery as related to authorization approvals and intensity of service.

　　Responsibilities

　　Referral and Eligibility Screening

　　Research client Medicaid benefits and behavioral health history in relevant databases to determine program eligibility based on complex health and risk factors.

　　Ensure that documents verifying client eligibility are saved for reference in client records.

　　Verify client Medicaid benefits monthly. Notify clinical staff and leadership of status changes and make necessary funding change entries in appropriate databases.

　　Maintain tracking list of new referrals to ensure appropriate follow up to referring partners and individuals; provide prompt and timely responses to inquiries about eligibility.

　　Authorization Tracking and Management

　　Review new client enrollments for accurate and complete record requirements. Coordinate corrections with the teams as needed through Task assignments, training and support.

　　With acute attention to detail, submit, or confirm submission of, all initial and renewal authorization requests to the program funder within established timelines.

　　Make note of all outgoing requests within the client records for tracking purposes.

　　Closely monitor reports to know which authorizations are pending submission, pending approval, approvals received, and denials requiring follow-up.

　　Coordinate necessary follow up with funder, clinical staff and program leadership to ensure that all FCS clients have an active authorization approval in a timely manner.

　　Maintain a master list of all authorization approvals and denials in order to assist with payment reconciliation. Ensure that authorization dates are correctly entered into client records for reporting purposes.

　　Review authorization denials or rejections and communicate with relevant team members to either re-submit requests with corrected information or ensure that services are discontinued appropriately and timely to avoid missed reimbursements.

　　Facilitate weekly team meetings of FCS administration and leadership team in reviewing reports related to authorizations, service utilization and missing information.

　　Notify staff monthly of upcoming re-authorization assessments due with enough advanced notice for staff to complete these in a timely manner. Track completion of these tasks and be available for technical assistance as needed.

　　Monitor reports related to service utilization, ensuring that any exception requests for high utilization is submitted to the program funder.

　　Training Management:

　　Develop and implement a required annual training program schedule for FCS staff record requirements and data quality via one-on-one, group classes, webinars, and any other technology available.

　　Track all FCS policy and training updates as released by the state or funder.

　　Take lead responsibilities to train and implement office strategies and provide ongoing training for compliance oversight and prevention of Medicaid Fraud and Abuse.

　　Develop a plan to ensure all updated policies are implemented, including training staff on changes.

　　Update training records for all FCS staff, including assign staff to internal and external training sessions and verify accurate documentation for external sessions.

　　Conduct routine audits to ensure staff are in compliance with all required trainings

　　Develop policies and methods to streamline data quality and contract compliance using available technology. Distribute these to FCS staff across multiple sites.

　　Fiscal Responsibilities:

　　Provide leadership with routine summaries on key performance indicators that would impact program revenue, such as volume of incoming referrals, new enrollments vs exits, staff direct service hours, and authorization delays that would lead to lost revenue.

　　Ensure that services provided by clinicians can be reimbursed by ensuring that all clients receive or maintain an approved active authorization for services from the program payer.

　　Ensure that there is prompt and timely follow up on authorization denials or rejections from clinical staff as needed, to prevent any loss of program reimbursements.

　　Ensure that individual service utilization is within the limits set by the funder. Request exceptions when additional services over the limits are needed to allow for reimbursement. Follow up with program funder to ensure these requests have been reviewed and approved.

　　Coordinate Quality Improvement and Client Records operations support:

　　Maintain open and closed files. Review charts for completeness and quality utilizing structured protocols and work with staff to obtain any missing documentation.

　　Provide technical assistance and training to staff about documentation requirements, charting, and related agency, funder, or licensor policies and regulations.

　　Assist site leadership to prepare for federal, state and county audits and site reviews; participate in audit/site review process, and help prepare responses to corrective actions.

　　Facilitate and organize internal chart reviews: assign reviews to staff, compile results, and prepare a summary to leadership teams with an emphasis on strengths and areas for improvement.

　　Help develop and maintain clinical and administrative workflows, as well as instructions and training guide materials.

　　Actively assist direct service staff to accurately complete charting activities and keep records updated for accurate outcome reporting and compliance with Medicaid requirements.

　　Oversight of Building, Communication, and Safety

　　Responsible for providing site leadership with checklists and necessary supports for office compliance with fire codes and ADA requirements.

　　Responsible for reviewing, updating, and distributing the Disaster Preparedness and Response Plans and provide updates to funders or review entities as requested.

　　Participate in appropriate Safety Committees and relay concerns to teams to make sure all hazardous situations are taken care of ASAP.

　　Ensure that staff have access to proper destruction of paper copies of client-related documents so that the program maintains a comprehensive paperless client record in compliance with HIPAA and agency protocols.

　　Responsible for upholding a culture of privacy and security in highly confidential work environment (HIPAA covered entity service area).

　　Complies with all CCSWW policies and procedures that involve access to and safeguarding of client Protected Health Information (all forms).

　　Holds leadership role in creating a culture of privacy and security of Protected Health Information in HIPAA Covered Entity service area, including education of staff about their responsibilities for safeguarding privacy and security.

　　Qualifications

　　Bachelor’s Degree in a human or social services field.

　　1 year of experience in contract monitoring, data monitoring, or program management.

　　Extraordinary attention to detail for a wide range of data points that influence payment.

　　Strong skills in both written and oral communication.

　　Ability to work independently and with a team.

　　Excellent knowledge of Microsoft 365 Programs, including SharePoint and Excel

　　Experience related to a fee-for-service funding structure and federal Medicaid requirements

　　Ability to relate well to staff and clients from a diverse racial, ethnic and/or cultural background.

　　Commitment to developing and safekeeping a workplace, which values and supports a culturally diverse work environment.

　　Ability to travel among work sites as needed.

　　Commitment to CCS Mission Statement.

　　PREFERRED QUALIFICATIONS:

　　Experience participating in state and federal audits.

　　Note to Internal Candidates: HR reviews internal compensation and determines any increase based on their experience and also agency internal equity factors.

　　Catholic Community Services and Catholic Housing Services is an Equal Opportunity Employer. Please let us know if you need special accommodations to apply or interview for this position.

　　Job LocationsUS-WA-Seattle

　　Posted Date1 week ago(1/19/2024 9:46 PM)

　　Job ID 2024-7522

　　of Openings 1Category Behavioral Health

　　Min USD $26.32/Hr.