Program Integrity Specialist

2 weeks ago

Auburn, ME, United States Health Affiliates Maine Full time

Health Affiliates Maine has an opening for a Program Integrity Specialist to join their team. This is a full-time, hourly (non- exempt), role.

This is a great opportunity for schedule stability and to use your expertise in mental health to support therapists, psychiatric providers, and case managers to serve their communities

Position Summary:

As the Program Integrity Specialist, you will have the knowledge and ability to interpret clinical information and be able to summarize the need for medical necessity and obtain authorization for services in Acentra. You will be responsible for completing continued stay reviews and prior authorizations for all services offered through Health Affiliates Maine and complete clinical chart audits to ensure compliance with Licensing and MaineCare requirements.

Roles and Responsibilities (Include but are not limited to the following):

  • Meet and Maintain MHRT-C requirements.
  • Have working knowledge of Licensing and MaineCare regulations.
  • Willingness to develop and maintain working knowledge of the agency's Program Integrity Policies and Procedures.
  • Create new client records and file original documentation needing to be maintained continuously.
  • Index incoming electronic health record documents to the client's electronic health record.
  • Complete requests for Prior Authorizations, Retro-active MaineCare, Hold for Service notifications, and meet quota for Continued Stay Reviews in Acentra following set procedures.
  • Complete clinical audits by reviewing client record documentation for all programs in adherence to MaineCare and Licensing Regulations.
  • Provide communication and feedback to all providers and supervisors regarding chart content and Acentra information.
  • Process SMI discharges in Acentra.
  • Follow up on any D/C client audit as needed to obtain any missing documents or originals.
  • Notify providers and agency staff of any QA paperwork holds being implemented due to non-compliance
  • Lift QA paperwork holds once required paperwork is received.
  • Audit client charts upon receiving notification of provider's termination to obtain needed records by the termination date.
  • Participate in Program Integrity meetings to ensure following set procedures, problem solve issues and improve quality of electronic health record maintenance.
  • Communicate regularly with Program Integrity Assistant Director about any Acentra or compliance issues.
  • Perform other duties as directed by the Program Integrity Assistant Director and Management Team.
Benefits (Include but are not limited to the following):

We recognize that our ultimate success depends on our talented and dedicated workforce. Our goal is to provide a comprehensive benefits package that promotes work-life balance to support you doing your best work.

Highlights include:
  • Extensive earned benefit time package including increase adjustments at 1 year, 5 year, 10 year and 15 year anniversaries
  • Flextime and condensed work week option
  • up to 12.5 paid Holidays
  • Financial programs including Dependent Care - FSA, 401k and financial advising
  • Health benefit programs including multiple medical options, onsite health coaching as well as paid life and disability insurance.
Requirements

Qualifications (Include but are not limited to the following):
  • Bachelor's Degree in a social service related field
OR
  • MHRT-C with the ability to interpret client documentation.

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