Quality Assurance and Compliance Manager

Employer:

TRAC Autism Center Inc.

Office location: 3290 W Big Beaver Rd, Troy, MI 48084, United States.

Work arrangement:
Remote.

Schedule:

Create your own schedule, Monday through Friday, within a 40-hour workweek.

Reports directly to:
Director of Operations and VP of Clinical Operations.

TRAC Autism Center Inc. is looking for an organized, approachable Quality Assurance and Compliance Manager who enjoys helping teams stay on track and making it easier for families to access Applied Behavior Analysis (ABA) services. In this role, you will manage quality assurance, compliance, provider credentialing, client intake, benefits verification, and service authorizations, working closely with our operations and clinical leaders.

This remote position offers the flexibility to create your own schedule within a 40-hour workweek, Monday through Friday. You will have room to organize your day while staying connected with the team, meeting payer and compliance deadlines, and keeping important processes moving. We are looking for someone who brings practical ABA or behavioral health experience, follows through on details, and takes a collaborative approach to solving problems.

• Manage provider credentialing, renewals, and enrollment for TRAC, its service locations, and individual practitioners across county Community Mental Health (CMH) agencies, Community Mental Health Services Programs (CMHSPs), regional Prepaid Inpatient Health Plans (PIHPs), Medicaid, and commercial insurance networks, as applicable.
• Keep an organized reference of county and payer requirements, including provider qualifications, application steps, contract conditions, and renewal deadlines.
• Prepare credentialing and enrollment applications, follow up on missing information, and track submissions, approvals, and participation effective dates.
• Keep CAQH Provider Data Portal profiles, Michigan CHAMPS records, NPI/NPPES information, payer portals, and county or regional profiles current. Coordinate provider attestations and access in accordance with each portal’s requirements.
• Maintain accurate provider rosters and supporting records, including practice affiliations, service locations, licenses, certifications, and professional liability coverage.
• Work with human resources and clinical leadership to verify licenses, BACB certifications, provider qualifications, exclusion screening, and required training records.
• Confirm that provider participation and payer billing requirements are in place before services are assigned or claims are submitted.
• Be the main administrative contact for credentialing and enrollment questions. Work with county and payer contacts to resolve issues and keep leadership informed of delays that could affect services or reimbursement.

• Guide families through the administrative intake process by sending intake packets, collecting and processing completed forms and supporting documents, checking for completeness, and following up on missing information.
• Keep intake records up to date and share timely updates with the VP of Clinical Operations on prospective client progress and outstanding intake needs for new and current clients.
• Complete timely insurance eligibility and ABA benefits checks for prospective clients, clients preparing to start services, and current clients. Record coverage dates, benefits, authorization requirements, and any coverage limitations or changes.
• Prepare, submit, and process ABA authorization requests, renewals, and changes, working with the clinical team to gather the necessary clinical documentation.
• Follow authorization requests through to a decision, follow up with payers, and keep the VP of Clinical Operations and relevant teams informed of approvals, denials, delays, and upcoming expirations.
• Keep clear authorization records, including approved services, authorization numbers, coverage periods, approved units, units used, and remaining balances.
• Track authorization units and utilization with the VP of Clinical Operations. Work with scheduling and billing to address discrepancies, approaching unit limits, under utilization, and renewal needs before they affect services or reimbursement.

• Maintain a practical compliance work plan and process for identifying risks related to federal and Michigan requirements, Medicaid rules, county and payer contracts,…