CAP POC Reviewer

Acentra Health, LLC•UNAVAILABLE, UNAVAILABLE

About The Position

Acentra Health is looking for a CAP POC Reviewer to join our growing team. The HCBS Plan of Care Reviewer is responsible for reviewing, evaluating, and processing Home and Community-Based Services (HCBS) waiver requests, Plans of Care, reassessments, and related documentation to ensure compliance with Medicaid policy, waiver requirements, contractual obligations, and program standards.

Requirements

Bachelor’s degree from an accredited college or university in Healthcare Administration, Business Administration, Public Health, Human Services, Social Services, Quality Management, or a related field.
Minimum of two years of experience in quality assurance, compliance, healthcare operations, program administration, auditing, documentation review, customer service, or a related field.
Experience interpreting and applying policies, procedures, contractual requirements, or program standards.
Excellent written and verbal communication skills.
Strong analytical, critical-thinking, and problem-solving skills.
Strong attention to detail with a commitment to accuracy and quality.
Ability to work independently, prioritize tasks, and manage multiple projects simultaneously in a fast-paced environment.

Nice To Haves

Master's Degree from an accredited college or university in a related field.
Experience working in a regulated environment.
Knowledge of and experience reviewing and participating in legal claims or polices from a clinical perspective.
Proficiency with Microsoft Office applications and other systems required to perform assigned responsibilities.
Ability to establish and maintain positive working relationships with internal and external stakeholders.
Ability to communicate concerns and recommendations professionally.
Ability to collaborate effectively in a team environment.

Responsibilities

Reviews records and documentation for contractual, regulatory, and organizational compliance.
Ensures assigned reviews are accurate, complete, and completed on time.
Documents findings, trends, concerns, and recommendations for leadership and stakeholders.
Participates in quality assurance, compliance monitoring, audits, and process improvement.
Identifies documentation gaps and supports corrective actions and process enhancements.
Maintains accurate tracking records for reviews, findings, and follow-up activities.
Manages workloads, prioritizes assignments, and adjusts workflows to meet operational needs.
Supports special projects, cross-training, workforce flexibility, and departmental continuity.
Advises staff and serves as a liaison among departments, providers, partners, and stakeholders.
Builds professional relationships and promotes teamwork, accountability, and customer service.
Maintains current knowledge of policies, procedures, program requirements, and training updates.
Protects confidential information, follows HIPAA and organizational requirements, and reports compliance or security concerns.