Quality Auditor

This position conducts audits prior to and after service delivery; conducts clinical engagement auditing; ensures compliance with established procedures, program fidelity design, applicable regulations, and/or management to assess effectiveness of controls, accuracy of financial records, and efficiency of operations. Serves as efficient support to staff members and demonstrates the ability to present one’s self, the agency, and the individuals we serve in a professional and positive manner.

• Conducts weekly prospective audit of scheduled appointments for any staff using the scheduling calendar. Checks to assure Assessment, Pre-Plan, Plan of Service, and authorizations are in place prior to service. Verifies Provider is billable to consumer’s insurance.
• Conducts pre-billing audit of all Wellvance home progress notes minimally at the end of each month.
• Assures required signatures are obtained for all Individual Plans of Service, addendums, and consents. Assures externally obtained signatures are scanned into Electronic Health Record (EHR). Monitors and assures verbal consents are correctly done and documented in the EHR and a follow up digital or wet signature is obtained within 45 days.
• Monitors and assures that consents for release of information to primary care providers are obtained annually for all clients.
• Assures annual documentation and paperwork is complete and in the EHR for all clients.
• Audits monthly residential paperwork including assuring that personal care logs are signed by home supervisors monthly.
• Monitors and assures that Plan of Service reviews are being done on a quarterly basis.
• Tracks and verifies documentation in the EHR that the plan of service was delivered in 15 days.
• Assists with tracking IPOS training for aide level staff and primary care coordination documentation.
• May assist Quality and EHR Compliance Specialist with County of Financial Responsibility activities as needed.
• Monitors various data issues regarding documentation and SALs and assures correction.
• Monitors the use of the general fund code to ensure the proper code was used.
• Assures compliance with internal, state, and federal regulations and engages in a monitoring process to measure accountability.
• Works closely and in concert with members of the Quality, Reimbursement, and Clinical Departments to ensure billing accuracy and regulatory compliance in numerous areas.
• May cross-train with the Compliance & Quality Supervisor.

Excellent Benefit Package includes:

• PTO (paid time off) Accrual Program
• Paid Holidays
• BC/BS PPO Medical Benefits
• Health Savings Account
• Flex Savings Account
• Dental
• Vision
• Pension Plan
• Tuition Assistance Program
• Student Loan Payment Assistance
• Term Life Insurance
• Short Term Disability Insurance
• Long Term Disability Insurance
• Voluntary Life Insurance
• AFLAC

• If you are having issues applying for a position or have questions about applying, email hr@wellvance.org

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

• Associate level degree preferred.
• Comparable progress towards a higher degree or comparable combination of education and experience level acceptable.

Knowledge, Skills and Abilities Required

• Must have command of the Electronic Health Record and a high level of proficiency using Microsoft Word and Excel.
• Must have the ability to think independently, problem-solve, and act in a manner consistent with board policy and agency procedures.
• Must have the ability to speak clearly and persuasively, listen and get clarification, and respond well to questions.
• Must write clearly and informatively, edit work for spelling and grammar, present numerical data effectively, and be able to read and interpret written information.
• Must possess strong organizational and administrative skills as demonstrated by the timely, accurate, and effective production of tasks assigned.
• Must work effectively in an independent or team environment.
• Must possess strong interpersonal skills as demonstrated by the ability to collaborate and cooperate with various departments to obtain common goals and values.
• Must consistently be at work and on time, ensure work responsibilities are covered when absent, and arrive at meetings on time.
• Must possess full knowledge of required standards and regulations and can operate in a confidential manner.

Certificates, Licenses, Registrations

• Maintain all required trainings and certifications.
• Possess a valid US driver's license.
• Provide proof of U.S. Citizenship or possession of necessary papers allowing holder to work legally in the United States.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Sit at a desk and work on a computer for prolonged periods of time, walk/move around and stand, talk and hear and use hands to handle, control or feel objects, tools or controls.
• Lift up to 10 pounds.
• Use close vision and ability to focus on computer screens and documents; distance vision; peripheral vison; depth perception; color vision.

Work Schedule

• Available Monday through Friday 8am to 6pm, flexibility for occasional weekend and after-hours support.
• Ability to travel between offices and local offsite locations may be required.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

• Perform duties in an office setting where the noise level in the work environment is usually moderate.
• Use standard office equipment such as computers, phones, and photocopiers routinely.

Wellvance has many opportunities for those looking to make a difference in the lives of our community members by providing beneficial and cost-effective services to our consumers. Wellvance provides State funded public mental health services to Iosco, Ogemaw, and Oscoda counties in northern Michigan. Services are provided to people with an Intellectual or Developmental Disability (I/DD), a Serious Persistent Mental Illness (SPMI), and/or those who may be Seriously Emotionally Disturbed (SED).

The right person will have the ability to demonstrate knowledge of, follow and utilize agency policies and procedures. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed within the organizational Job Description for this position are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Candidates must be able to work a flexible schedule and travel throughout the Board's coverage area and, at times, around different areas of the state. Possession of a driver's license valid in the State of Michigan, vehicle insurance as required by Michigan Law, and a good driving record; be a U.S. Citizen or have possession of necessary papers allowing holder to work legally within the United States.