Provider Network Auditor

SCCMHA JOB VACANCY ANNOUNCEMENT  

CLASSIFICATION: Provider Network Auditor

PAY GRADE: $60,316.69 - $74,235.18 Annually

POSITION SUMMARY:                     

Under general supervision of the Provider Network Auditing Supervisor, responsible for conducting program audit functions for Saginaw County Community Mental Health Authority (SCCMHA) as part of a compliance and quality performance program to safeguard against fraudulent or erroneous claims of consumer service provision on behalf of SCCMHA.  Working with approved regulatory and contractual guidelines and SCCMHA policies, this position will work individually or in a team to initiate, compile, complete, document and analyze audit findings for SCCMHA.  Audits both contracted and board operated programs.  Verifies event documentation and identifies system deficiencies by provider (i.e. billing code and modifier deficiencies).  Reviews provider service delivery records and may conduct contractor compliance reviews.  Presents summary information to key SCCMHA management team staff as requested or indicated.  Represents SCCMHA to the provider network in monitoring and compliance measurement verbal and written communications.  Required to develop in-depth knowledge of service requirements for varied SCCMHA programs.  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 consumer in the recovery process.  

WORKING CONDITIONS/ENVIRONMENT:

Works in normal office environment with usual pressures of dealing with time constraints.   Works as a member of an audit team and department member.  Because of multiple provider sites of SCCMHA and the need to visit programs on site, it is common to drive to several locations; sometimes in bad weather.  Works with a variety of providers, staff, programs and consumers.

QUALIFICATIONS:

Education:      Bachelor’s degree in social work, psychology, or closely related human services field and knowledge of health care administration, or a Bachelor’s in a business related area required.   

Experience:    A minimum of five (5) years of experience in health care, business or related financial or program field.  Audit and/or data analysis experience preferred.  Human service experience and/or knowledge preferred.  Business, finance and computer skills, including spread sheet functions, are required.  A general knowledge of mental health system, and compliance or medical records experience would be helpful. Knowledge of adult foster care licensing and other service system accreditation requirements helpful.  Demonstrated writing and presentation skills are required.

Licenses and Certifications:    Valid Michigan Driver’s license with a good driving record.