Program Specialist

POSITION SUMMARY :

The Program Specialist is responsible for the recruiting and credentialing Provider Agencies for the Mental Health Waiver. The Program Specialist is also responsible for the collection of data, data recording and data management related to Provider Agencies in the WISE program.  The WISE program seeks to move individuals with serious mental illness from nursing homes into the community, or assist client already in the community to remain there.  The program arranges for housing, community supports, and on-going services.  ABH®’s roles include :  (1) to identify, credential, train and contract providers; (2) assist in program implementation; (3) pay claims; (4) collect and report data; and (5) manage quality improvement.  This position will represent ABH® and its services in a positive and professional manner and adhere to ABH®’s best practices, guidelines, policies and procedures as established, promoting ABH® as a leader in behavioral healthcare in all interactions and work.

DUTIES AND RESPONSIBILITIES :

• Assist in outreach and recruitment activities to obtain new Mental Health Waiver Providers
• Review and process prospective Provider applications. Enter data into an information system for tracking and reporting purposes;
• Provide customer service functions for WISE providers;
• Monitor the work flow of Provider application requests and the resultant determinations and approvals in regards to meeting or exceeding the contractual requirements for WISE work processing;
• Plan and coordinate trainings;
• Maintain and track re-credentialing spreadsheet.  Process re-credentialing paperwork and plan site visits as needed;
• Coordinate with DSS / DXC as needed to maintain Medicaid Provider status for ABH and Providers;
• Assist in program implementation and program changes;
• Suggest enhancements to work flow processes, information systems, and other non-personnel related processes;
• Comply and work towards goals established by DSS, DMHAS and ABH®;
• Maintain internal communications; notify supervisors with all relevant client or program-based information;
• Attend all required staff, supervision and training meeting;
• Maintains confidentiality of all client protected health information and adheres to all HIPAA and 42 CFR related policies and procedures;
• Demonstrated ethical behavior and cultural sensitivity in all activities involving individuals of diverse backgrounds;
• Performs other tasks / responsibilities as required to support the business operations.

Requirements

EDUCATION AND EXPERIENCE REQUIREMENTS :

KNOWLEDGE / SKILLS / ABILITIES :