Manager of Network Services and Supports

Saginaw County Community Mental Health Authority•Saginaw, MI

23h•$84,784 - $113,712•Onsite

About The Position

Under the general supervision of the Executive Director of Network Services, Public Policy, and Enhanced Health Services, this role provides agency leadership for Auditing services and processes, including internal and external reviews, Home and Community Based Services Rules, and Credentialing as it relates to regulatory requirements and billing for services provided by SCCMHA and its network providers. This position serves as the liaison between SCCMHA and residential providers, community living supports providers, and community inclusion and skill building providers. The role requires knowledge of residential services to assist individuals in obtaining the least restrictive living settings and promoting community access. The position must be knowledgeable about and actively support culturally competent recovery-based practices, person-centered planning as a shared decision-making process, and a trauma-informed culture of safety to aid individuals in their recovery process.

Requirements

Bachelor’s degree in human services or a business-related area with specific program or financial auditing experience.
At least 5 years of experience in health care, business, or a related financial or program field.
Experience must include some business-related functions.
Business, finance, and computer skills, including spreadsheet functions, are required.
Must be able to provide samples of varied, quality written work.
Valid Michigan Driver’s license with a good driving record.
Knowledge of billing and credentialing processes including Substance Use.
Knowledge of AFC Licensing, Health Care credentialing, and health care compliance review process.
Ability to prepare professional routine correspondence or analytical reports is essential.
Ability to exercise independent, and mature judgment, diplomacy, discretion, interpersonal problem solving and attention to detail abilities are required.
Ability to represent the organization in a positive, professional manner.
Ability to manage multiple priorities at once.
Data base experience.
Familiarity with excel and excel spreadsheets.
Demonstrated accuracy with detailed work.
Good communication and interpersonal skills.
Ability to learn and explain complex federal and state regulations, and Medicaid regulations.
Ability to relate to individuals from all social, cultural, and economic backgrounds.
Hearing acuity to converse in person and on telephone.
Visual Acuity to read and proofread documents.
Ability to walk, stand, or sit for extended periods of time.
Manual dexterity to write and to operate standard office equipment (PC, Keyboard, Copy Machine, Fax Machine, etc.).
Ability to regularly lift and carry files and supplies at least 30 pounds.
Ability to reach, bend, or stoop to manage charts or supplies up to 30 pounds.
Strong interpersonal skills to interact with leadership, employees, consumers, providers, and the general public.
Mental capacity to think independently, follow instruction and use judgment.
Ability to use tact and courtesy with others.
Ability to plan short and long range and to manage and schedule time.
Ability to handle stress in meeting deadlines and dealing with diverse individuals in daily work.
Ability to protect confidential documents and information with discretion.

Nice To Haves

Master’s degree with knowledge and experience in a business-related field or financial auditing experience.
Audit and/or data analysis experience preferred.
Behavioral health field, physical health care, human service experience, and/or knowledge preferred.
A general knowledge of mental health systems, disability supports systems, and compliance or medical records desired.

Responsibilities

Supervises the Provider Network Auditing Supervisor and the Credentialing Coordinator, understands Auditing processes, oversees the Auditing Unit, and reports concerns to upper management.
Works with the Auditing unit on compliance reviews such as Medicaid Event Verification (MEV) Reviews, Michigan Department of Health and Human Services (MDHHS) waiver reviews, Office of Inspector General (OIG), and substantiated office of recipient rights complaints requiring provider sanctions.
Oversees the audit unit's annual plan to meet organizational goals.
Reports audit scores and event verification findings to upper management and posts annual audit scores on the SCCMHA website. Annually reports trends among provider categories to leadership.
Understands credentialing processes and supervises the Credentialing Coordinator, providing guidance on new credentialing requirements from various insurances and governing bodies.
Serves as a member of the credentialing committee and the coding and benefit integrity committee.
Understands coding and credentialing, oversees credentialing for billable services according to various insurances (Medicaid, Medicare, commercial), ability to pay, and sliding fee schedules. This includes knowledge of verification processes for appropriate billing and compliance with healthcare responsibilities for credentialing providers under their licensure.
Has knowledge about credentialing for Substance Use Treatment.
Assures changes to policies and procedures and develops procedures related to the Auditing Unit and credentialing policies and procedures.
Provides leadership in Home and Community Based Services (HCBS) Rules, working closely with directors and supervisors to ensure awareness of rule/interpretation changes and compliance.
Works closely with residential, community living supports, community inclusion, and skill building network providers.
Works closely with the SCCMHA contracts department regarding securing residential placement options for individuals served by Saginaw County Community Mental Health Authority.
Works closely with the SCCMHA finance department to ensure implementation of credentialing changes related to billing.
Oversees needs in residential services, including specialized, licensed, and unlicensed residential services under contract with SCCMHA, and assists SCCMHA with developing new residential settings, ensuring compliance with HCBS rules and SCCMHA standards.
Works with skill building and community living supports providers to ensure HCBS compliance and problem-solve concerns.
Works with respite providers to ensure compliance with Medicaid manual requirements.
Serves as the liaison between residential, community living supports, and respite providers and SCCMHA.
May serve as liaison to the Mid State Health Network (MSHN) monitoring committees to provide input into tools used across all MSHN CMH’s.
Handles confidential materials related to credentialing and auditing of providers.
Performs administrative tasks as assigned by the Executive Director of Network Services, Public Policy, and Enhanced Health Services, which may involve any area of department operations.
Is a member of the Residential Placement Committee and Residential Watch Committee.
Is a member of one of the QI committees, such as accountability.
Adheres to the mission, vision, core values, and operating principles of Saginaw County Community Mental Health Authority (SCCMHA) at all times.
Represents the units or department/department director as requested at internal or provider meetings.
Performs various administrative/clerical functions such as preparing travel vouchers, making copies of documents, filing, etc.
May participate in fidelity or other quality and audit related functions.
Attends meetings, seminars, workshops, and community events related to the public mental health mission and in order to sustain professional competency.
Reacts productively to change and handles other essential tasks as assigned.
Required to drive to off-site locations.
Uses computer hardware and software to perform tasks.