Description

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

Job Responsibilities:

Have working knowledge of Licensing and MaineCare regulations.
Willingness to develop and maintain working knowledge of the agency’s Program Integrity Policies and Procedures.
Assist Program Integrity Assistant Director and Team Leader with Licensing Survey’s and MaineCare Audits.
Create new client records and file original documentation needing to be maintained continuously.
Pull and file back client records for CSR’s, scan and index documents needed for CSR to client electronic health record.
Monitor and assist in the organization and management of paperwork requested for the purpose of CSR’s.
Notify providers and agency staff of any QA paperwork holds or PWH being implemented due to non-compliance.
Sort incoming paperwork and tracking documents that are received, including monitoring of releases of information and upload to appropriate area in electronic health record.
Audit incoming documentation for compliance with MaineCare and Licensing Regulations.
Manage rotation of full provider audits to send for assigned providers to work toward compliance with MaineCare and Licensing Regulations quarterly at a minimum, with timely follow up reports.
Manage and route paperwork needing revision.
Audit client charts upon receiving notification of provider’s termination to obtain needed records by the termination date.
Help to educate providers on auditing and paperwork requirements, providing support through the audit process.
Communicate regularly with the Program Integrity Assistant Director regarding any ACENTRA related issues.
Effectively communicate timely and professionally with providers, their supervisors, and Program Integrity Assistant Director throughout the audit process.
Review daily ACENTRA batch downloads and input authorizations into electronic health record and Atrezzo Encounters tool.
Discharge clients in ACENTRA and problem-solve any related issues.
Follow up on any D/C client audit as needed to obtain any missing paperwork or originals.
Support Program Integrity department by taking minutes at meetings as applicable.
Participate in Program Integrity meetings to ensure following set procedures, problem solve issues, and improve quality of electronic health record maintenance.
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):

Administrative and Billing Experience