Program Integrity Director
Smoky Mountain Center - Waynesville, NC

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Program Integrity (PI) DirectorHaywood County SMOKY MOUNTAIN CENTERFor Mental Health, Developmental Disabilities,And Substance Abuse Services44 Bonnie LaneSylva, NC 28779www.smokymountaincenter.org828-586-5501GENERAL STATEMENT OF JOB The Program Integrity (PI) Director works under the direct supervision of the Sr. Director-Waiver Contract Management. The position is responsible to provide for program integrity by applying mental health knowledge and expertise of North Carolina Medicaid mental health services in the post payment review of all covered mental health services. Position must have thorough knowledge of Medicaids mental health coverage policies and be able to apply them in ensuring program compliance. This position will organize and direct the activities of the Billing Audit Team and the Special Investigation Team. The PI Director shall assist in the planning, development, coordination and oversight of routine billing audits and special investigations for provider agencies that contract to provide services for consumers whose eligibility for services lies within the Smoky Mountain Center (SMC) catchment area. These reviews shall be designed to assist in improving the SMC provider network service delivery program by identifying areas of error, incorrect payments, and possible fraud, waste for billing abuse. The PI Director shall make presentations of abnormal or suspicious billing audit results to the Corporate Compliance Committee (CCC) for a determination regarding the need for a special investigation. Position must have the ability to determine correct coding, documentation, potential Medicaid fraud, abuse, and over utilization by providers and recipients. The position will review claims, medical records and billing data from all types of mental health providers that bill Medicaid. :
QUALIFICATIONS & CREDENTIALING REQUIREMENTS: Required Minimum Training: Masters degree in a human services field or in a related field and two years of experience in mental health, developmental disabilities and/or substance programs one of which was in a consultative capacity; or graduation from a four-year college or university with a degree in a human services field or in a related field and four years of experience in a mental health, developmental disabilities, and/or substance program, two of which were in a consultative capacity; or an equivalent combination or education and experience. Addition Training/Experience: 2 years experience in the analysis of mental health services in a Community Mental Health Program, Strong skills in writing, communication, and interpersonal skills. Must be able to work as a team member as well as independently. License preferred. PHYSICAL REQUIREMENTS: This position experiences a high degree of mental exertion. This position regularly handles situations that require extensive evaluation and critical thinking. It is imperative that this position be able to work with others in team planning efforts and to problem solve complex situations. Person in this position is required to have close visual acuity to perform activities such as preparation and analysis of data and figures; viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. SALARY Grade/Step is determined by qualification and experience of candidate. Position is full-time comprehensive benefits. Work schedule is 37.5 hours per week. APPLY TO:Send a NC State Application and resume to:Smoky Mountain Center, Department of Human Resources, 44 Bonnie Lane, Sylva, NC 28779. Smoky Mountain Center is an equal opportunity, affirmative action employer.