Provider Network Auditing Supervisor

Salary Range: $80,060.84 To $ Annually

SCCMHA JOB VACANCY ANNOUNCEMENT

Pay Range: $80,060.84 - $ annually

POSITION SUMMARY:

Under general supervision of the Manager of Network Services and Supports, 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.

ESSENTIAL DUTIES AND RESPONSIBLITIES:

1. Supervises the provider network audit function. Key aspects of the auditing function include at minimum an annual provider monitoring process against established standards and the review of a minimum number of random service events against claims and other records to ensure proper documentation of publicly funded services. Ensures that provider network services audit requirements measure provider performance against the comprehensive standards and requirements of SCCMHA.

2. Supervises the implementation of an annual audit plan to meet organizational goals. Responds to ad hoc audit needs, including provider performance concerns of validity of purchased or SCCMHA provided services. Oversees the establishment of audit samples, schedules and plans for audit team members. Conducts presentations on the audit function or outcomes to provider groups and SCCMHA departments. Ensures the SCCMHA audit schedule and related time frames are maintained.

Supervises provider network data base and audit files relative to audit scores and supporting detail. Ensures meaningful persons served involvement by policy or as appropriate in the provider monitoring function. Supervises SCCMHA required submission of corrective action plans by providers and monitoring to meet standard or improvement goals.

3. Hires, orients, trains and supervises department staff. Creates audit schedule and assigns specific audits or audit tasks to provider network auditors. Reviews all audit reports and provider corrective action plans. Coordinates function and auditors work with other SCCMHA departments or units. Provides specific and appropriate priority coordination with Contract and Training department staff on provider performance, as well as SCCMHA Fiscal and Compliance staff on provider event verification matters.

4. Supervises audit program development; recommends modifications to tools, procedures, or documentation to improve processes or to meet changing policies or requirements of SCCMHA. Ensure provider feedback on audit process and plans. Responds to provider type communication needs or issues regarding audits and event verification. Recommends quality improvements in the audit area to SCCMHA management. Stays abreast of provider documentation and organizational compliance requirement changes.

5. Issues routine audit program reports or summaries or ad hoc reports as requested or indicated. Participates in and contributes to quality improvement, compliance, contract, or fiscal management, clinical management, or recipient rights coordination of department.

6. Works with department and management leadership,…