Self Directed Services Analyst

3 weeks ago

Jackson, United States LifeWays Full time
Job DescriptionJob Description

Under the direction and supervision of the Supervisor, Contract Procurement, the Self Directed Service Analyst ensures compliance and improved performance by developing and managing Self Direction budgets including utilization review. The Self Direction Service Analyst works closely with the Fiscal Management Services (FMS) provider analyst to ensure that all billing and claims have the required documentation in the chart as part of the Clean Claim Review (CCR) and Medicaid Event Verification (MEV) processes. The Self-Directed Service Analyst ensures that all billings and claims are acceptable according to local, state, and federal requirements

Essential Functions:

  • Uses professional judgement to identify concerns and to recommend corrective action.
  • Provides education to consumers and their families regarding Self-Direction principles, roles, and responsibilities in an arrangement.
  • Assists in developing training protocols and materials on Self-Direction.
  • Develops and completes service budget to support arrangement with individual/supports and FMS.
  • Completes monthly review of budget expenditures.
  • Assists in the development and coordination of quality assurance processes for the ongoing evaluation of Self Direction and related initiatives.
  • Coordinates and provides in-service on Self Direction for internal and external customers in Self- Direction.
  • Oversees the Self-Determination initiative, including the gathering of consumer/family/provider perceptions of progress, satisfaction, etc., as well as maintains communication and coordination of services with the individual's case manager/supports coordinator.
  • Responsible for ensuring that all individuals understand choice options.
  • Collaborates with the FMS Contract Liaison with decisions regarding approval and/or rescinding of an arrangement and for the transition into appropriate supports and level of care to meet identified needs as outlined in Individual Plan of Service (IPOS).
  • Navigates the Electronic Medical Record (EMR) to ensure all billing and claims are made against active treatment plans.
  • Uses analytics and record reviews to identify discrepancies in claims, including inconsistencies in duration of services, units utilized, codes billed, rates claimed, or qualification of staff. Utilizes professional discretion to request correction from providers when applicable. Makes independent recommendations to the Finance Department for claims that require payback by the provider or pull back of encounters from the state.
  • Maintains working knowledge of local, state, federal, and accreditation requirements for service codes, billing, and claims.
  • Coordinates preparation for MEV audits by payors by ensuring review of Self Directed MEV sample and follow-up on findings.
  • Responsible for adherence to all Commission on Accreditation of Rehabilitation Facilities (CARF) and Michigan Department of Health and Human Services (MDHHS) standards.
  • Maintain regular and predictable attendance.
  • All other duties as assigned.

Required Education/Certification/Licensure:

  • Bachelor's degree in human services or related field or equivalent experience.
  • Mental Health First Aid Training, upon hire.
  • Must have reliable transportation*
  • Two years' experience in Community Mental Health Services

Preferred Education/Certification/Licensure:

  • Five years' experience in Community Mental Health services.
  • Budget development and Financial Oversight experience
  • CPR, AED, and First Aid Training.

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