LTSS Contract Adherence Auditor

Elevance Health • Kingsport, TN

2d • Remote

About The Position

LTSS Contract Adherence Auditor Location: candidate must reside in the state of Tennessee. Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The LTSS Contract Adherence Auditor is responsible for participating in auditing and contract adherence activities to ensure the Long Term Services and Supports program adheres with applicable state laws and contractual requirements. How you will make an impact: Prepares and ensures completion of internal and external audits, adherence reporting and tracking/monitoring processes as assigned. Audits LTSS work to ensure appropriate and consistent administration of contract requirements. Performs external audits including enrollee record review, new member and short term stay, MCO to MCO, Level of Care and Employment and Community First audits. Responds to on demand state audit requests. Responsible for Annual Quality Survey and Annual Network Audit reviews, audit participation and presents audit results. Provides internal Person Centered Support Plan auditing and comprehensive adherence auditing. Documents audit findings in a timely, accurate and concise manner. Tracks activities such as daily critical incident submissions, short term stay, Individual Experience, Employment and NCI surveys and caseload tracking. Ensures clinical licensure adherence with contract requirements. Completes monthly reports such as short term stay, caseload staffing and ratio reporting. Responds to legislative inquiries and other on demand request per contract agreement. Maintains knowledge of tracking tools and databases, and prepares reports to document contract adherence issues. May educate staff about contract requirements to ensure contract adherence. Participates in projects, initiatives and process improvement activities. May serve as an internal resource, mentor and coach for new associates.

Requirements

• Requires BA/BS and RN, LPN/LVN, LSW, LCSW, LMSW, LBSW, BSW, or MSW in accordance with applicable state law and minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background.
• Licensed clinicians hired into this role require current, unrestricted RN, LPN/LVN, LSW, LCSW, LMSW, LPC, or LBSW (as allowed by state law) in applicable state(s).

Nice To Haves

• LTSS experience preferred.
• Computer experience including Microsoft Office Suite including Outlook, Word and Excel preferred

Responsibilities

• Prepares and ensures completion of internal and external audits, adherence reporting and tracking/monitoring processes as assigned.
• Audits LTSS work to ensure appropriate and consistent administration of contract requirements.
• Performs external audits including enrollee record review, new member and short term stay, MCO to MCO, Level of Care and Employment and Community First audits.
• Responds to on demand state audit requests.
• Responsible for Annual Quality Survey and Annual Network Audit reviews, audit participation and presents audit results.
• Provides internal Person Centered Support Plan auditing and comprehensive adherence auditing.
• Documents audit findings in a timely, accurate and concise manner.
• Tracks activities such as daily critical incident submissions, short term stay, Individual Experience, Employment and NCI surveys and caseload tracking.
• Ensures clinical licensure adherence with contract requirements.
• Completes monthly reports such as short term stay, caseload staffing and ratio reporting.
• Responds to legislative inquiries and other on demand request per contract agreement.
• Maintains knowledge of tracking tools and databases, and prepares reports to document contract adherence issues.
• May educate staff about contract requirements to ensure contract adherence.
• Participates in projects, initiatives and process improvement activities.
• May serve as an internal resource, mentor and coach for new associates.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level