Provider Compliance and Certification Support Reviewer

Job Description

Job Description

SUMMARY

Conducts regular and special compliance reviews as determined by DODD and Provider Compliance and Support Manager. Responsible for reviewing the quality of service being delivered by the private provider, and makes recommendations for improvements. Delivers citations to providers as applicable and works directly with the department on compliance issues. Serves as a liaison between providers and SCBDD.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Conducts provider compliance reviews in accordance with applicable requirements as set by OOC OSSAS and meets with other ISP team members as appropriate to coordinate and facilitate the provider compliance process across service environments;
• Reviews files, service delivery documentation, personnel records and conducts interviews with persons served, guardians (if applicable), Service and Support Administrators, and providers of service to assess compliance with applicable rules;
• Delivers citations, recommends suspension and / or suspension with proposed revocation to the department as applicable, additionally, makes recommendations for improvement;
• Reviews provider documentation based on established procedures to identify if services are being delivered according to the ISP and make recommendations for improvement;
• Conducts site visits to provider day programs and residential settings;
• Identifies areas of concern regarding health, safety, and / or quality of services and supports based on direct observation, interviews, reviews of documentation, and solicitation of feedback from appropriate advocates.
• Conducts intensive monitoring of sites that have been identified as potentially non-compliant or in need of additional support to assure health and safety;
• Provides support to new providers to assist them with initial certification requirements, initial education on Medicaid billing, completion of SCBDD New Provider Orientation, and Billing Office Hours.
• Conducts provider training to enhance services and supports and educates providers on Federal and State Standards as needed;
• Assists in the administrative duties related to provider access to the Relias Learning Management System, or other training and support systems offered by SCBDD;
• Compiles, completes, and submits Medicaid Fraud Reports to DODD Manager and Provider Compliance and Support Manager;
• Conducts internal audits of ISPs utilizing the most current Compliance Review Tool distributed by DODD;
• Completes required reports in a timely manner, communicates results of monitoring activities and provides feedback to appropriate persons as directed;
• Demonstrates current understanding of the programs being monitored, the rules which impact / govern that programming, etc., in order to keep current and maintain credibility with providers.
• Follows all State and Federal rules as well as Board policies;
• Participates in interdisciplinary meetings to discuss areas of concern and make recommendations for improvements as needed, as well as advocate for technical assistance and training to service providers;
• Completes accurate documentation in keeping with requirements of the County Board as well as any applicable Medicaid requirements;
• Reports Major Unusual Incidents to include alleged abuse / neglect in accordance with HB 403, Ohio Revised Code 5123, Administrative Rule 5123 : 17-02, and County Board Policies and Procedures;
• Reports any concerns needing immediate attention (ie. health, safety, or rights violations) or possible MUI's per applicable requirements;
• Assists the individual with due process when necessary;
• Performs special tasks or projects as assigned, and adheres to a flexible work schedule designed to meet individual needs.

An integral part of the job function is ensuring that services, supports and oversight of such supports occurs with the focus on the individual receiving services. Person-centered planning is the foundation for all services, supports, monitoring, supervision and coordination for the individuals served.

Valid Ohio Driver's License and evidence of good driving record and full liability coverage on any vehicle used for transportation

Bachelor's Degree in related field, experience with individuals who have developmental disabilities, and eligibility for Provider Compliance Certification.

Benefits :

Health, dental, life, flexible spending, and voluntary benefits along with paid sick time, holiday pay, vacation time, and personal days. Ohio Public Employee's Retirement System (OPERS), tuition reimbursement, employee assistance program, and wellness program.