About Centria Healthcare
Every child deserves the brightest future and Centria Autism Services is on a mission to help children with Autism Spectrum Disorder (ASD) have the best developmental experience possible while acquiring the skills to succeed in the world on their own terms. Too many children with ASD are untreated or undertreated and Centria is committed to reaching every child in need and their families with interventions based on the principles of Applied Behavior Analysis that meet – and exceed -- best practices. Our Optimal Outcomes Model(TM) looks at the whole-child, engages families in aspirational treatment planning and leverages team-based care to allow BCBA’s to focus on clinical issues and support Centria’s dedication to quality, family satisfaction and developmental outcomes. Founded in 2009, Centria now operates in 13 states and is working hard to develop approaches to sustain quality while reaching tens of thousands of children across the country; we use data-driven analytics and sophisticated software platforms to constantly evaluate our quality and performance, and develop new approaches to supporting our clients and their families on their journey.
Position Summary
The Contract Compliance Under the direction of the Contract Director, the Contract Compliance Specialist will work closely with clinical and operational personnel to ensure comprehensive contractual compliance and adequate preparation for payor
audits.
Success Measures
Program requirements, execution of assigned tasks, and a positive relationship with payors as demonstrated by
Duties and Responsibilities
The below reflects the essential functions considered necessary for this role and shall not be construed as a detailed description of all work requirements inherent in the job or assigned by supervisory personnel. This job description is used as a guide only and not inclusive of all responsibilities and job duties.
- Support Quality Compliance Team activities and functions within the Contracting Team 70%
- Work across multiple internal systems to ensure comprehensive contractual
- Interface with the Contracts Department in researching payor and company requirements to respond to contract compliance inquiries and to inform potential areas of improvement.
- Perform compliance audits to monitor adherence to payor contractual requirements and to maintain readiness for future audits.
- Work collaboratively with clinical and operational staff to address external Corrective Action Plans (CAPs) and monitor necessary action items for
- Management System, as well as payor portals, internal systems, dashboards, and all other necessary information systems to ensure the full breadth of the compliance process can be examined.
- Assist with Quality Compliance Team activities related to audit preparation to include pre-audit assessments and document collection activities.
- Payor Relations Activities (Michigan) 20%
- Participates in relationship management with Community Mental Health (CMH) organizations to include meetings with relevant leaders and other stakeholders regarding any new developments or potential issues within the payor or provider communities.
- Meet with DCSs as directed to communicate CMH updates, summarize recent audit outcomes,
- Store and catalog all payor communications for future review if
- Participate in relationship management for CMHSP/PIHP/CMHAM, ORR, new Michigan government administrative units, etc.
- Represent Centria on Michigan provider panels and at association meetings as directed
- Projects
- Participate in the implementation of new compliance initiatives and processes.
- Assist with ad hoc reports as
Managerial Responsibility
The role of the Contract Compliance Specialist acts as an individual contributor with no direct reports.
Key Fiscal Responsibilities
This role has no budgetary control or financial oversight responsibilities.
Qualifications
10%
These guidelines can be used to make a list of qualifications required (or preferred) to perform the job successfully. Experience may be substituted for the educational requirement.
Education
Equipment and Technology Requirements
- Laptop
- G Suite (Gmail, Drive, Docs, Sheets, Google Meet)
- Microsoft Office (Word, Excel Access, PowerPoint)
Other Competency Requirements
An initial assessment of competency will be completed during the interview period and evaluated on an ongoing basis.
- Ability to follow written instructions
- Ability to use computers and computer/software programs
- Ability to communicate expressively and receptively
Knowledge and Skills
- Excellent communication skills, both written and verbal;
- Data-driven with an aptitude for interpreting results and firm adherence to process;
- Comprehensive understanding of payor requirements and proficiency in navigating CareConnect;
- Track record of success in payor audit responses;
- Knowledge of ABA requirements for nationwide payors;
- Strong understanding of Centria operational processes with the ability to work collaboratively with other departments in collecting documentation;
- Knowledge of computer systems related to compliance, operational, and HR functions;
- Knowledge of audit and compliance process;
- Knowledge of medical terminology and clinical concepts;
- Ability to organize, prioritize and handle multiple tasks, adhere to established deadlines, and produce work that consistently meets or exceeds team benchmarks;
- Proven adaptability with a willingness to work both collaboratively and individually to achieve desired business outcomes;
- Excellent interpersonal and listening skills;
- Demonstrated strong work ethic with attention to detail, accuracy, and quality;
- Established track record of generating error-free
Interpersonal Demands
The options below best characterize the nature and level of interactions with other people in the course of performing this job.
- Some interactions with other teams
- Some interactions with key internal and external stakeholders
Decision Making
The option below best characterizes the level of decision making exercised in performing this job.
- Mostly choosing from other options suggested by leaders and/or teammates
Working Conditions
- Centria's office hours are Monday through Friday from 8:30 AM 6:00
- Additional time or occasional shifts in schedule may be required to complete the above work or meet company objectives.
- Overtime is not a planned part of this role; if required, overtime must be pre-approved in writing by a department
Physical Demands
While performing the duties of this job, physical requirements such as bending, reaching, lifting, pushing, or pulling up to 30 pounds may be required. This role will require sitting most of the day as well as walking and standing periodically. This role may require close visual acuity on computer screens or monitors and the ability to analyze data and figures on a screen.
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, Veteran status, or disability status. This job description is not intended to be an exhaustive list of qualifications, skills, efforts, duties, responsibilities, or working conditions associated with the position. Centria reserves the right to amend this job description at any time, with or without written notice.
