Job Therapy Provider Network Compliance Specialist

Compliance Auditor

Overview of Position : Under limited supervision, the Compliance Auditor conducts routine audits to ensure the accuracy of coding and the sufficiency of associated provider documentation, maintaining best practice compliance standards. The auditor performs on-site and off-site pre- or post-charge audits on participant accounts to determine coding accuracy. Additionally, the auditor reviews files and charts in clinics to ensure the healthcare facility complies with standards established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), as well as federal Medicare / Medicaid programs, state programs, and the facility's established criteria.

Salary : $97k-110k

Responsibilities

Audit, monitor, and oversee therapy service providers : Conduct thorough audits of occupational therapy, physical therapy, and speech-language pathology service providers to ensure compliance with National Committee for Quality Assurance (NCQA) standards and Credentialing and Re-credentialing requirements (CR 11). This includes evaluating administrative management practices, emergency plans, accommodations, physical facility conditions, and medical record-keeping practices. Travel for compliance audits : Utilize a personal vehicle to travel to therapy centers and contracted therapy providers to conduct on-site audits. Ensure that these providers adhere to established compliance standards and regulations. Develop and manage performance improvement plans : Create, monitor, and manage performance improvement plans for network providers based on audit findings. Work collaboratively with providers to implement necessary changes and improvements. Oversee organizational security and confidentiality : Audit and monitor the security, confidentiality, and access to medical records within the organization. Ensure that all practices comply with relevant regulations and standards. Provide quarterly status reports : Prepare and present detailed quarterly status reports to the Director of Therapy Provider Network, Regional Vice President, and Vice President of Therapy Services. These reports should include audit findings, compliance status, and recommendations for improvement. Document and address concerns : Record and follow up on any concerns or grievances related to the delivery of therapy services. Ensure that issues are resolved promptly and effectively. Conduct initial assessments : Perform initial assessments for participants referred for Occupational Therapy services, which will constitute 25% of the productivity component. Ensure that assessments are thorough and meet established standards. Perform other duties as assigned : Carry out additional tasks and responsibilities as required to support the overall compliance and auditing functions of the organization.

Qualifications

Education : Master's degree required in Occupational Therapy. A valid (California) license to practice in the incumbents respective discipline, Must be a licensed Occupational Therapist Current board certification as required.

Experience : 3 to 4 years' experience in the delivery of occupational therapy with individuals diagnosed with Autism.

Knowledge, Skills, Abilities : Strong communication skills, both orally and written. Assignments are received in the form of results expected but incumbent has considerable freedom to decide on work priorities and procedures to be followed.