Summary of Responsibilities: To assure compliance with all agency, state, and federal regulatory requirements and standards. This is to include but is not limited to evaluating and analyzing filing systems, creating tracking systems and making recommendations to the Compliance Manager on upcoming regulatory changes.
- Complete file audits on agency programs and departments.
- Preform interviews for administrative staff
- Interpret policy and procedure to maintain proper file compliance.
- Keep up to date with latest requirements with Medicaid and insurance filing
- Report back to Compliance Manager on audit review.
- Bring information back to CQI team for discussion.
- Teach file compliance to all levels of staff and keep them current with any and all changes.
- Work in partnership with managers to achieve realistic deadlines
- Bachelor’s degree preferred
- Associate’s degree with four years’ experience in compliance review required.
- Experience in reviewing Medicaid Billing and service files/records.
- Experience with non-profit social services or mental health agencies or in an insurance company or managed care administrator.
- Knowledgeable in social service programs such as OMH, OPWDD, ORR and foster care.
- Dedication to high quality record keeping, along with the ability to analyze and evaluate files and determine necessary steps of action.
- Strong writing skills with the ability to proof read and edit.
- Excellent attention to detail and time management skills.
- Strong ability to work independently as well as with a team.
- Excellent communication and interpersonal skills.
- Advanced knowledge in Excel, Word and Publisher and willingness to learn other programs.
- Ability to handle confidential material in a responsible manner.
- Ability to travel with little notice to all agency locations.
As a full time benefits position, staff is eligible to enroll in medical, dental, vision, FSA, supplemental life insurance, critical illness, enhanced short-term disability, and 401(k) benefits.
Level of Language Proficiency
Minimum Education Required