Quality Assurance and Compliance Manager

HR Alliance•Troy, MI

4d•Remote

About The Position

TRAC Autism Center Inc. is seeking an organized, collaborative Quality Assurance and Compliance Manager to support access to Applied Behavior Analysis (ABA) services. The role manages quality assurance, compliance, provider credentialing, client intake, insurance benefits verification, and service authorizations while working closely with operations and clinical leaders. It is remote and allows the employee to create a schedule within a 40-hour Monday-through-Friday workweek. The manager oversees provider credentialing and enrollment across county Community Mental Health agencies and programs, regional PIHPs, Medicaid, and commercial insurance networks as applicable. The role maintains provider and payer records, coordinates attestations and qualifications checks, tracks applications and renewals, and works with external contacts to address enrollment issues. It also supports families through administrative intake, verifies insurance eligibility and ABA benefits, processes authorization requests, and monitors authorization units and deadlines. The position maintains compliance processes and policies relating to federal and Michigan requirements, Medicaid, contracts, privacy and security, recipient rights, and applicable ABA ethical standards. It organizes audits and record reviews, supports corrective actions, coordinates audit and inquiry responses, and works with billing, scheduling, intake, and clinical teams to ensure services, authorizations, provider eligibility, documentation, and claims are consistent. The role also coordinates staff education and training records, reports key risks and progress to leadership, and may supervise assigned quality assurance or credentialing staff, if applicable. The role is remote, involves regular computer use and confidential record review, and may occasionally require attendance at audits or external meetings based on TRAC’s service locations. Dependable communication and timely completion of work are expected. Essential functions may be performed with reasonable accommodation.

Requirements

Bachelor’s degree in healthcare administration, business administration, public health, psychology, behavioral health, or a related field; an equivalent combination of relevant education and substantial professional experience may be considered.
At least three years of relevant healthcare or behavioral health experience in quality assurance, compliance, credentialing, or provider enrollment, including direct experience supporting ABA services.
Hands-on provider credentialing experience across multiple county CMH/CMHSP or regional PIHP networks, including applications, renewals, supporting documents, and follow-up.
Experience maintaining online provider profiles and enrollment records, including CAQH, payer portals, and county or regional systems; working knowledge of Michigan CHAMPS or a comparable Medicaid enrollment system.
Working understanding of ABA documentation, provider qualifications, and payer requirements.
Practical experience with client intake, insurance eligibility and benefits checks, ABA authorization requests, and tracking authorization units and utilization with clinical leadership.
Experience reviewing records or conducting audits, identifying compliance gaps, and helping teams complete corrective actions.
Knowledge of HIPAA, healthcare confidentiality, Medicaid compliance, recipient rights, and fraud, waste, and abuse prevention as they relate to the work.
Organized and dependable approach, clear communication, and ability to balance deadlines, handle confidential information, and work through concerns with others.
Comfort using electronic health records, practice management systems, Microsoft Office or similar tools, and spreadsheets for tracking and reporting.
Dependable communication, coordination with colleagues and external contacts, and timely completion of intake, authorization, credentialing, and compliance work.

Nice To Haves

Five or more years of experience in ABA or behavioral health compliance, quality assurance, or credentialing, especially with team leadership or program management.
Familiarity with ABA compliance, documentation, credentialing, or provider network requirements in Ottawa, Genesee, Shiawassee, and Oakland counties, including work with their CMH agencies or regional PIHP networks.
Experience with payer audits, Medicaid documentation reviews, accreditation preparation, or building a compliance program.
A relevant certification, such as Certified in Healthcare Compliance (CHC), Certified Professional in Healthcare Quality (CPHQ), or Certified Provider Credentialing Specialist (CPCS).
A master’s degree in a related field or relevant ABA certification or licensure.
BCBA certification; helpful for clinical collaboration but not required.

Responsibilities

Manage provider credentialing, renewals, and enrollment for the organization, its locations, and individual practitioners across relevant county CMH/CMHSP agencies, regional PIHPs, Medicaid, and commercial insurance networks.
Maintain references on county and payer requirements, prepare applications, track submissions and approvals, and follow up on missing information or enrollment issues.
Keep CAQH, Michigan CHAMPS, NPI/NPPES, payer portal, county, and regional provider profiles and records current, and coordinate required attestations and portal access.
Maintain provider rosters and supporting records, and work with human resources and clinical leadership to verify qualifications, licenses, certifications, exclusion screening, and training records.
Confirm provider participation and payer billing requirements before services are assigned or claims are submitted; serve as the administrative contact for credentialing and enrollment questions.
Guide families through administrative intake, collect and review forms and supporting documents, follow up on missing information, and update relevant leaders on client progress.
Verify insurance eligibility and ABA benefits; record coverage dates, requirements, limitations, and changes.
Prepare and process ABA authorization requests, renewals, and changes; follow requests through payer decisions and communicate approvals, denials, delays, and expirations.
Maintain authorization records and track approved services, coverage periods, units, utilization, balances, and renewal needs in coordination with clinical, scheduling, and billing teams.
Maintain a compliance work plan and processes for identifying risks related to applicable requirements, contracts, privacy and security, recipient rights, and ABA ethical standards.
Work with operations and department leaders to review and update policies and procedures, organize deadlines and document versions, and communicate regulatory or payer updates to staff.
Coordinate HIPAA privacy and security activities with designated personnel, including system access, information sharing, record retention, and incident response.
Maintain confidential channels for staff concerns and help leadership and counsel review and document potential violations, discrepancies, conflicts of interest, or suspected fraud; promptly escalate significant concerns.
Organize regular audits of client records, personnel files, credentialing records, and administrative processes using consistent checklists and risk-based priorities.
Partner with clinical leaders to address documentation gaps, agree on corrective steps, and follow through on resolution; analyze audit results, incidents, family feedback, and workflows to recommend improvements.
Work with clinical operations to review safety incidents, grievances, and adverse events and develop corrective and preventive actions.
Coordinate with billing, intake, scheduling, and clinical teams to confirm consistency among services, authorizations, provider eligibility, documentation, and claims; help resolve coding, modifier, unit, service-limit, supervision, or payer-requirement discrepancies.
Coordinate county reviews, payer audits, regulatory inquiries, and accreditation reviews when applicable; organize records, submit timely responses, and track findings and corrective action deadlines.
Support repayment or disclosure processes when needed and directed by leadership.
Coordinate staff education on credentialing, documentation, privacy, recipient rights, reporting responsibilities, and policy updates; maintain training records and track completion and renewal deadlines.
Provide leadership updates on credentialing, intake, benefits, authorizations, utilization, audit results, documentation, corrective actions, incidents, and risks.
Help lead cross-department improvements, clarify follow-up ownership, and supervise assigned quality assurance or credentialing staff if applicable.
Build positive working relationships with staff, families, county representatives, and payers while handling confidential information carefully and reviewing concerns fairly.