Contract Adherence Auditor-Medicaid

Description

Description - External

Contract Adherence Auditor-Medicaid

Be part of an extraordinary team

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high performance culture that empowers you to make an impact?

The Contract Adherence Auditor is responsible for participating in auditing and contract adherence activities to ensure the Long Term Services and Supports program adheres with applicable state laws and contractual requirements.

Primary duties may include, but are not limited to:

• Prepares and ensures completion of internal and external audits, adherence reporting and tracking/monitoring processes as assigned.
• Audits LTSS work to ensure appropriate and consistent administration of contract requirements.
• Performs external audits including enrollee record review, new member and short term stay, MCO to MCO, Level of Care and Employment and Community First audits.
• Responds to on demand state audit requests.
• Responsible for Annual Quality Survey and Annual Network Audit reviews, audit participation and presents audit results.
• Provides internal Person Centered Support Plan auditing and comprehensive adherence auditing.
• Documents audit findings in a timely, accurate and concise manner.
• Tracks activities such as daily critical incident submissions, short term stay, Individual Experience, Employment and NCI surveys and caseload tracking.
• Ensures clinical licensure adherence with contract requirements.
• Completes monthly reports such as short term stay, caseload staffing and ratio reporting.
• Responds to legislative inquiries and other on demand request per contract agreement.
• Maintains knowledge of tracking tools and databases, and prepares reports to document contract adherence issues.
• May educate staff about contract requirements to ensure contract adherence.
• Participates in projects, initiatives and process improvement activities.
• May serve as an internal resource, mentor and coach for new associates.

Qualifications - External:

Minimum Requirements:

• Requires BA/BS and RN, LPN/LVN, LSW, LCSW, LMSW, LBSW, BSW, or MSW in accordance with applicable state law and minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background.
• Licensed clinicians hired into this role require current, unrestricted RN, LPN/LVN, LSW, LCSW, LMSW, LPC, or LBSW (as allowed by state law) in applicable state(s).

Preferred Skills, Capabilities and Experiences:

• LTSS experience preferred.
• Computer experience including Microsoft Office Suite including Outlook, Word and Excel preferred

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.