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Medicaid Compliance Specialist

Services for the Underserved

Description

Company Overview: As a leading provider of residential and support services to individuals with special needs, Services for the UnderServed provides the resources you need to build on your experience amidst our culture of team support. Ongoing training and attention to your development help to ensure your success. Your achievements and leadership are rewarded by advancement opportunities. Our commitment to continuous quality improvement impacts the lives of our clients and communities while contributing to the development of our employees.



Position Summary:

The Medicaid Compliance Specialist will conduct documentation reviews to ensure compliance with Medicaid/ Medicare billing guidelines as well as specific policies of all insurance carriers.



Responsibilities:
•Responsible for reviewing documentation for billing for Developmental Disabilities certified programs, OASAS licensed residential and outpatient substance abuse treatment, OMH outpatient mental Health programs, ACT Teams, Licensed OMH Housing, Care Coordination and Clubhouse to ensure compliance with billing/coding requirements of Office of Medicaid Inspector General, OMH and other regulatory agencies.
•Review and audit the quality of clinical case documentation and services.
•Conduct documentation training with staff regarding billing requirements for services provided.
•Perform retrospective, concurrent, and prospective audits to ensure all CPT codes billed are supported by documentation in the medical record and are compliant with State and Federal regulations.
•Ensure compliance with HIPAA and other regulatory requirements for responsible areas.
•Review service plans to assure goals are realistic, reflect consumer input, and respond to consumer strengths and needs.
•Responsible for conducting unannounced visits to programs sites to perform observations/fire drills.
•Perform related assigned duties.
•Must be flexible regarding work schedule and be able to work early mornings and late evenings.
•Must be able to travel citywide.

Qualifications

•Bachelor’s Degree required however Master’s Degree preferred.


•Minimum 2 years of experience as a quality assurance staff member within a Human Services organization.


•Experience conducting documentation reviews to ensure compliance with regulatory requirements.


•Experience working with consumers or in programs which provided services to consumers with Developmental Disabilities (DD)/ Behavioral Health (BH)/ OASAS/ Veterans/ Shelter Services and / or People Living with AIDS (PLWA).


•Minimum 1 year of experience in intermediate levels of MS Word, Excel, Outlook.


•Flexibility to work on special projects after regular office hours and on weekends and ability to travel throughout the boroughs.

Contact

Apply at https://sus_org.jobs.net/en-US/ or email gltaveras@sus.org

Posted on 05/09/17; CVMHA ID #10997