Job Description

Health Affiliates Maine has an opening for a

Program Integrity Specialist

to join their team. This is a full-time, hourly (non- exempt), role.

This is a great opportunity for schedule stability and to use your expertise in mental health to support therapists, psychiatric providers, and case managers to serve their communities!

Position Summary:

As the

Program Integrity Specialist

, you will have the knowledge and ability to interpret clinical information and be able to summarize the need for medical necessity and obtain authorization for services. You will be responsible for completing continued stay reviews and prior authorizations for all services offered through Health Affiliates Maine and complete clinical chart audits to ensure compliance with Licensing and Mainecare requirements.

Roles and Responsibilities

(Include but are not limited to the following):

Meet and Maintain MHRT-C requirements Have working knowledge of Licensing and MaineCare regulations Willingness to develop and maintain working knowledge of the agency's Program Integrity Policies and Procedures Index incoming electronic health record documents to the client's electronic health record Complete requests for Prior Authorizations, Retro-Active MaineCare, Hold for Service notifications, and meet quota for Continued Stay Reviews in Acentra following set procedures Provide communication and feedback to all providers and supervisors regarding chart content and Acentra information Process SMI discharges in Acentra Notify providers and agency staff of any QA paperwork holds being implemented due to non-compliance Lift QA paperwork holds once required paperwork is received Participate in Program Integrity meetings to ensure following set procedures, problem solve issues, and improve quality of electronic health record maintenance

Qualifications

(Include but are not limited to the following):

Bachelor's Degree in a social service-related field
OR

MHRT-C with the ability to interpret client documentation.
Benefits (Include but are not limited to the following):

Earned Benefit time + 12.5 paid holidays Health, Dental, Vision, LTD, STD, Life Benefits 401k Retirement Savings Employee Assistance Program (EAP) Wellness Program
Job Type: Full-time

Pay: From $45,760.00 per year

Work Location: In person