Project UM Audit & Documentation Director

United States • ,

6d • Remote

About The Position

The Project Utilization and Documentation Director supports UM Leaders and their department operations at assigned facilities, ensuring medical necessity, compliance, and financial performance. This role utilizes Behavioral Health treatment and medical necessity expertise, payer audit readiness, and documentation excellence to optimize reimbursement at facilities in collaboration with facility leaders and corporate partners. This employee will be responsible for providing expert guidance and advice on all aspects of clinical documentation integrity, clinical protocols, and payor reimbursement and payor audit compliance in Acadia facilities.
This position involves up to 100% travel to support assigned facilities and may include evenings and weekends based on need.

Requirements

• Bachelor’s degree in Nursing or other clinical degree required
• At least 5 years’ Supervisory experience in Intake and Utilization Management/Review or Case Management preferred
• Strong knowledge of payor clinical guidelines and audit processes, experience writing appeal letters, and strong working knowledge of documentation that meets payor reimbursement standards
• Significant behavioral healthcare experience in a variety of settings and service lines
• Knowledge of insurance billing requirements preferred
• Effective and accurate oral and written communication skills
• Possesses the ability to effectively influence facility leadership, teams and corporate partners to embrace required operational shifts by clearly articulating the long-term benefits of the new expectations
• Knowledge of office administration procedures with the ability to operate most standard office equipment
• Ability to work professionally with sensitive, proprietary data & information while maintaining confidentiality
• Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external
• Self-motivated with strong organizational skills and superior attention to detail
• Must be able to manage multiple tasks/projects simultaneously within inflexible time frames. Ability to adapt to frequent priority changes
• RN, LPC, LCSW, or LMFT is required

Nice To Haves

• At least 5 years’ Supervisory experience in Intake and Utilization Management/Review or Case Management preferred
• Knowledge of insurance billing requirements preferred

Responsibilities

• Provides on-site leadership to assess and analyze current Intake and Utilization processes, challenges and outcomes; including compliance and regulatory requirements are met
• Audit patient charts at assigned facilities to ensure accuracy, completeness, and compliance with regulatory standards and practice guidelines. Identify discrepancies or missing information and take corrective action with team members providing care at the facility.
• Performs facility audits of clinical and financial information related to denial management including length of stay, medical necessity documentation, precertification, concurrent authorizations, compliance with Medicare Certification/Recertification, Medicare Internal Audits, and compliance with EMTALA standards
• Ensure that all records and documentation practices comply with HIPAA regulations and other relevant healthcare laws and standards. Participate in internal audits and implement corrective actions as needed
• Conduct regular quality checks on medical records and scanned documents to maintain high standards of accuracy and completeness. Report any issues or concerns in real-time to care providers and clinical leaders at the facility.
• Generate and maintain reports on chart audits, compliance issues, and other relevant data. Provide insights and recommendations to improve record-keeping processes and documentation practices.
• Serves as resource for education and training to physicians and clinical staff on current documentation and regulations
• Support the development and sustainment of action plans for the resolution of problematic issues or to address areas of compliance vulnerability
• Assist in the development of Process Improvement practices in facilities and maintenance of same including analysis of data and prioritization of efforts as needed
• Collaborates with clinical services to ensure clinical documentation provides rationale to ensure authorization is obtained via successful process and utilization of the patient’s individualized benefit is achieved
• Provides consultation and guidance regarding written level of care guidelines for a variety of payors
• Provides consultation and guidance regarding the appeal process. Assists facility UM staff in creating effective appeal letters
• Ensures proper use of Medhost, the Medhost dashboard, and Sharepoint.
• Maintains current knowledge of applicable regulations and regulatory update in the behavioral health field
• Performs other duties as assigned
• Complies with organizational policies, procedures, performance improvement initiatives and maintains organizational and industry policies regarding confidentiality
• Communicate clearly and effectively to person(s) receiving services and their family members, guests and other members of the health care team
• Develops constructive and cooperative working relationships with others and maintains them over time
• Encourages and builds mutual trust, respect and cooperation among team members.
• Maintains regular and predictable attendance

Benefits

• Competitive Base Salary commensurate with experience
• Bonus eligible
• Comprehensive Medical, Dental, and Vision Insurance
• 401(k) Plan with Company Match
• Paid Time Off (PTO) and recognized holidays
• Company-paid Basic Life and AD&D Insurance
• Employee Assistance Program (EAP) and mental wellness resources
• Opportunities for professional growth and advancement within Acadia’s nationwide network

What This Job Offers

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