Provider Network Auditing Supervisor

Saginaw County Community Mental Health Authority•Saginaw, MI

13d•$80,061 - $105,916•Hybrid

About The Position

Under general supervision of the Manager of Network Services and Supports, this role is responsible for supervising the provider network services auditing program of the Saginaw County Community Mental Health Authority (SCCMHA). The auditing unit is responsible for part of a compliance and quality performance program to safeguard against fraudulent or erroneous claims of persons served service provision and is a primary source of the required monitoring of provider performance on behalf of SCCMHA. Oversight of audit functions includes both contracted and SCCMHA operated services and program units that provide direct services to persons served. The position develops and refines audit tools and processes that meet SCCMHA contractual and legal obligations by source reference. The position ensures proper and professional documentation and appropriate routine communications of provider monitoring and event verification functions as well as integrity and consistency in the audit process, measures, and data. Provides analysis and summary data to the SCCMHA management team on audit outcomes as planned or requested. Coordinates unit functions with contract management, training, and recipient-rights areas, as well as other programs or units of SCCMHA as indicated. This position also oversees the aspects of Home and Community Based Services Rules. This position will be knowledgeable about and actively support culturally competent recovery based practices; person centered planning as a shared decision making process with the individual, who defines his/her life goals and is assisted in developing a unique path toward those goals; and a trauma informed culture of safety to aid persons served in the recovery process.

Requirements

Bachelor’s degree in social work, psychology, or closely related Human Services field and knowledge of health care administration, or a Bachelor’s in a business-related area, with specific program or financial auditing experience.
A minimum of five (5) years of experience in health care, business or related financial or program field.
Experience must include some business-related functions.
Business, finance, and computer skills, including spread sheet functions, are required.
A general knowledge of mental health systems, and compliance or medical records desired.
Must be able to provide samples of varied, quality written work.
Analytical ability, finance, math and/or research skills, organization strengths and effective written and verbal communication skills are essential.
Ability to prepare professional routine correspondence or analytical reports is essential.
Computer skills are required.
Ability to exercise independent and mature judgment; diplomacy, discretion, interpersonal problem-solving, and attention-to-detail abilities are required.
Ability to manage conflict and quickly shift and/or manage multiple work priorities.
Ability to represent the organization in a positive, professional manner.
Ability to provide educational support to providers on service topic and provider compliance areas.
Hearing acuity to converse in person and on telephone.
Visual Acuity to read and proofread documents and use electronic health record.
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 lift and carry files and supplies at least 20 pounds.
Strong interpersonal skills to interact with leadership, employees, persons served and the general public.
Analytical skills necessary to conduct research, analyze, and interpret complex data and identify and solve problems by proposing courses of action.
Ability to plan short and long range and to manage and schedule time.
Ability to handle stress in meeting deadlines and dealing with large numbers of employees and/or persons served.

Nice To Haves

A Master’s degree is preferred.
Audit and/or data analysis experience preferred.
Human service experience and/or knowledge preferred.
Clinical experience is helpful.

Responsibilities

Supervises the provider network audit function, including annual provider monitoring and review of random service events against claims and records.
Supervises the implementation of an annual audit plan, responds to ad hoc audit needs, and oversees the establishment of audit samples, schedules, and plans.
Hires, orients, trains, and supervises department staff, creates audit schedules, assigns tasks, and reviews audit reports and corrective action plans.
Supervises audit program development, recommends modifications to tools and procedures, and ensures provider feedback on the audit process.
Issues routine and ad hoc audit program reports or summaries.
Works with department and management leadership to improve the audit program and functional operations.
Alerts Department and SCCMHA management regarding serious, immediate findings.
Alerts the Office of Recipient Rights of any issues that might pertain to a violation of the Michigan Mental Health Code.
Provides education to staff or providers on audit standards.
Works with Mid-State Health Network (MSHN) on performance reviews as part of reciprocity agreements.
Provides leadership and coordination for all MSHN, MDHHS and other site reviews that require gathering proof documents from the provider network.
Provides leadership and coordination with SCCMHA Human Resources for any documents required for MSHN or MDHHS reviews.
Provides leadership and is involved in the MSHN Medicaid Event Verification process.
Attends MSHN workgroups related to audit functions for various reviews.
Interprets and implements changes in federal, state, PIHP, and organizational requirements affecting provider monitoring, auditing, and compliance activities.
Oversees the workload and function of the Residential Placement Liaison and HCBS Coordinator.
Assures the HCBS Coordinator is educated and familiar with Home and Community Based Services (HCBS) Rules and monitors ongoing compliance.
Assures routine agendas and minutes are completed by the Residential Placement Liaison for the Residential Placement and Residential Watch Committees.
Assures the Residential Placement Liaison is vetting and reviewing potential specialized residential settings and General AFC settings.
Attends the MSHN HCBS workgroup and provides feedback to appropriate stakeholders.
Ensures that all information relevant to contract action is communicated and approved by designated management team members.
Performs other duties and responsibilities as assigned by supervisor.
Communicates the mission, vision, and core values of SCCMHA to staff while holding them accountable and implements these principles in all duties of this position.
Represents the unit or department/department director as requested at internal or provider meetings.
May attend conferences, workshops, seminars and read job-related publications to maintain professional competency in position.