Program Integrity Auditor I

Health Affiliates Maine has an opening for a Program Integrity Auditor I to join their team. This is a full-time, non-exempt role. 

Job Responsibilities:

• Have working knowledge of Licensing and MaineCare regulations.
• Willingness to develop and maintain working knowledge of the agency’s Program Integrity Policies and Procedures.
• Assist Program Integrity Assistant Director and Team Leader with Licensing Survey’s and MaineCare Audits.
• Create new client records and file original documentation needing to be maintained continuously.
• Pull and file back client records for CSR’s, scan and index documents needed for CSR to client electronic health record.
• Monitor and assist in the organization and management of paperwork requested for the purpose of CSR’s.  
• Notify providers and agency staff of any QA paperwork holds or PWH being implemented due to non-compliance. 
• Sort incoming paperwork and tracking documents that are received, including monitoring of releases of information and upload to appropriate area in electronic health record.
• Audit incoming documentation for compliance with MaineCare and Licensing Regulations. 
• Manage rotation of full provider audits to send for assigned providers to work toward compliance with MaineCare and Licensing Regulations quarterly at a minimum, with timely follow up reports.
• Manage and route paperwork needing revision.
• Audit client charts upon receiving notification of provider’s termination to obtain needed records by the termination date.
• Help to educate providers on auditing and paperwork requirements, providing support through the audit process.
• Communicate regularly with the Program Integrity Assistant Director regarding any ACENTRA related issues. 
• Effectively communicate timely and professionally with providers, their supervisors, and Program Integrity Assistant Director throughout the audit process.
• Review daily ACENTRA batch downloads and input authorizations into electronic health record and Atrezzo Encounters tool.  
• Discharge clients in ACENTRA and problem-solve any related issues. 
• Follow up on any D/C client audit as needed to obtain any missing paperwork or originals.
• Support Program Integrity department by taking minutes at meetings as applicable. 
• Participate in Program Integrity meetings to ensure following set procedures, problem solve issues, and improve quality of electronic health record maintenance.
• Perform other duties as directed by the Program Integrity Assistant Director and Management Team. 

Benefits (Include but are not limited to the following):

We recognize that our ultimate success depends on our talented and dedicated workforce. Our goal is to provide a comprehensive benefits package that promotes work-life balance to support you doing your best work.

Highlights include:

• Extensive earned benefit time package including increase adjustments at 1 year, 5 year, 10 year and 15 year anniversaries
• Flextime and condensed work week option
• up to 12.5 paid Holidays
• Financial programs including Dependent Care – FSA, 401k and financial advising
• Health benefit programs including multiple medical options, onsite health coaching as well as paid life and disability insurance.

Qualifications (Include but are not limited to the following):

• Administrative and Billing Experience