Job Description

Job Duties
  • Evaluate the case for compliance to applicable regulations.
    • Clearly communicate evaluation requirements and follow up.
    • Evaluate documentation against applicable State/Federal regulations.
    • Collect data and documentation to support compliance findings.
    • Utilize technology to convert hard copy documentation to electronic and submit via secure file transfer.
    • Record, summarize, and communicate compliance findings for the Social Adult Day Care program.
    • Assist in determining trends in non-compliance.
    • Make appropriate and timely recommendations to project management.
  • Utilize clinical expertise and knowledge to ensure compliance to applicable regulations and provide guidance to non-clinical team members, clients, and other appropriate parties.
  • Assist with the ongoing operationalization of project's processes and procedures.
  • Assist with all internal and external reporting, as needed, and related to QA reviews.

Required Qualifications
  • A minimum of 2 years of experience as a Registered Nurse (RN), Licensed Mental Health Counselor (LMHC), Licensed Clinical Social Worker (LCSW), Care Manager, or Medicaid Provider, in a role working with critical care providers, public health providers, or providers that care for children, older adults, persons with traumatic brain injury, persons with emotional disturbances, or persons with developmental disabilities.
  • Experience with monitoring program compliance or Medicaid fee-for-service and/or Managed Care billing.
  • Proficiency in MS Excel, MS Word, MS Outlook, MS Visio, MS PowerPoint, and MS SharePoint.

Preferred/Desired Qualifications
  • Extensive knowledge of, and experience with, Social Adult Day Care.
  • Experience working with eMedNY, CANS-NY, UAS-NY, or other related Medicaid programs or systems.
  • Experience working with NYS Department of Health (DOH), Office of Mental Health (OMH), Office for People with Developmental Disabilities (OPWDD), or Office of Children and Families (OCFS).
  • Experience with NYS Medicaid billing, including the use of various Electronic Health Records (EHR) systems.
  • Experience with compliance audits or chart reviews.
  • Ability to work with and relate to staff and demonstrate active listening skills.
  • Process oriented and results-driven work strategy.
  • Ability to foster teamwork with all levels of management and staff.
  • Ability to work well independently and within a team.
  • Exceptional customer service relationship techniques, including superior verbal and written communication skills.
  • Excellent accuracy and attention to detail.
  • Experience in meeting deadlines and adhering to strict standards of performance.
Equal Opportunity Employer: E claro values diversity anddoes not discriminate based onRace, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

Application Instructions

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