Job Description
The Medicaid Compliance Auditor is responsible for participating in auditing and contract adherence activities to ensure that Retreat adheres with applicable laws, regulations, and contractual requirements for the Florida Statewide Medicaid Managed Care (SMMC) program.
Primary duties may include, but are not limited to:
· Oversees Medicaid compliance in accordance to Retreat’s mission, code of ethics, and integrity
· Prepares and ensures completion of internal and external audits, adherence reporting, and tracking/monitoring processes
· Audits work and charts to ensure appropriate and consistent administration of contract requirements and CMS guidelines. Works with executive leadership and management to drive compliance into Retreat’s business plans, metrics and processes
· Responds to on demand state and/or federal audit requests.
· Responsible for quality reviews, audit participation, and presents audit results. Ensures compliance risks and audits are address and corrective action plans taken
· Documents audit findings in a timely, accurate, and concise manner. Assures timely implementation of all state and federal regulations
· Tracks and monitors activities including but not limited to critical incidents, patient experience, caseload track and NCI surveys
· Works with HR to ensures clinical licensure adherence with contract requirements.
· Maintains knowledge of tracking tools and databases and prepares reports to document contract adherence issues.
· Other duties as assigned by oversight board
Qualifications
Minimum Requirements:
· AA/AS and minimum of 5 years related experience
or
· BA/BS and minimum of 3 years related experience
Preferred Skills, Capabilities and Experiences:
· Florida SMMC experience preferred
· Licensed RN, LPN/LVN, LSW, LCSW, LMSW, LBSW, BSW, or MSW in accordance with accordance with state law
· Health care auditing certification preferred
· Computer experience including Microsoft Office Suite including Outlook, Word and Excel preferred
Company Description
Retreat Behavioral Health is a respected provider of substance use disorder and mental health treatment services. With a number of locations along the East Coast and a multitude of inpatient and outpatient services, Retreat’s goal is to help people easily access the best quality of care in a holistic and peaceful environment. We are in-network with most major insurances, and our admissions department operates 24/7. Our on-site clinical and medical staff are leaders in their fields, committed to working tirelessly on behalf of our patients.
Retreat Behavioral Health
Retreat Behavioral Health is a respected provider of substance use disorder and mental health treatment services. With a number of locations along the East Coast and a multitude of inpatient and outpatient services, Retreat’s goal is to help people easily access the best quality of care in a holistic and peaceful environment. We are in-network with most major insurances, and our admissions department operates 24/7. Our on-site clinical and medical staff are leaders in their fields, committed to working tirelessly on behalf of our patients.