Job description

Essential Functions of the Role: This position records, aggregates, analyzes, and reports audit results, identifying error trends and root causes, and making recommendations for performance improvements. Conducts standard random and focused audits to determine compliance with all funding sources listed here but not limited to Medicaid, OMH, Westchester County Department of Mental Health, DOH. Initiates facilitate and promote activities to foster compliance awareness and to encourage reporting of compliance issues within the organization and related entities. Manage workflow for Health Home HARP clients to enroll in Home and Community Based Services (HCBS).

Monitor compliance with all policies, procedures, and documentation requirements for HCBS. Supervise HCBS staff and ensure all requirements are met for billing submission. Educate employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, Medicaid, and PHI as well as conduct training in other areas as needed. Conduct periodic audits for performance management and proper coding.

Identify and recommend process improvement initiatives based on audit trends. Maintain an accurate database of audit results. 2 Participate in the review of departmental productivity and performance reports and takes an active part in the development of action plans for agency performance improvement. Remain updated on all member and provider policy changes made by the Health Home, Medicaid, HCBS, and other governing agencies.

Update existing or draft new policies to reflect current regulations. Work with all departments to ensure member satisfaction and timely resolution of grievances and appeals reports. Manage database and spearhead review process for agency incidents, complaints/grievances. Work closely with the Corporate Compliance Committee to draft and review existing policies on an ongoing basis to ensure alignment with new/updated regulations and determine the effectiveness of adoption cross-departmentally.

Perform other duties as assigned

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