Are you a behavioral health clinician looking to move from direct care to an administrative role? Are you a compassionate individual looking to make an impact on the lives of others? Would you like to continue the development of your clinical acumen?
Community Behavioral Health (CBH), part of Philadelphia's award-winning Department of Behavioral Health & Intellectual disAbility Services (DBHIDS), has an exciting opportunity for a Behavioral Health Compliance Analyst
The Behavioral Health Compliance Analyst conducts audits of provider policies, procedures, clinical, and billing systems to ensure that services have been provided in accordance with CBH contracts and are meeting regulatory, clinical, and best practice standards.
Performs regular and special compliance audits of provider clinical records against claims paid.
Reviews DBHIDS required policies and procedures.
Educates provider staff around issues of policy and procedure.
Forwards quality concerns to Quality Review for resolution.
Performs clinical audits and makes decisions about quality of care and best practice issues.
Correlates and analyzes data acquired through the audit process.
Prepares written reports in a timely manner for all audits and special projects that includes analysis of the collected data and recommendations for internal and external actions to be considered.
Maintains records, reports, and verbal communication required to ensure the flow and tracking of information.
Identifies potentially fraudulent provider activity through audits, reports from clients, providers and from internal sources.
Monitors the Compliance Hotline and answer calls as they come in. Completes the hotline call-sheet and with supervisory input develops a follow-up plan.
Collects, tracks, and reviews data for provider profiling and trending purposes.
Assists, as needed, with the completion of the Quarterly Report and other relevant State reporting activities.
Updates the CBH Compliance Audit Logs and Tracking Document.
Completion of a master's degree program at an accredited college or university in a behavioral health or closely related discipline.
Four (4) years' experience post-masters degree in assessment and/or counseling within an adult or child/adolescent behavioral health treatment setting.
Possession of a valid proper class motor vehicle operator's license as issued by the Commonwealth of Pennsylvania, and an acceptable Motor Vehicle Report (MVR) prior to appointment and during tenure of employment, and have own transportation.
Pennsylvania Child Abuse History Clearance and F.B.I. Clearance
Knowledge of behavioral health therapeutic modalities, with emphasis on current best practices within the field.
Knowledge of medical necessity criteria for Pennsylvania Client Placement Criteria (PCPC) and the Adolescent Placement Criteria (ASAM).
Knowledge of psychotropic and physical health medications, interactions, contraindications, side effects, and appropriateness of use in relation to diagnosis.
Knowledge of Diagnostic and Statistical Manual of Mental Disorders (DSM) IV.
Knowledge about medical assistance regulations as well as knowledge of the laws, regulations, and guidelines in the behavioral health disciplines.
Knowledgeable about services the provider is contracted/budgeted to provide.
Knowledge of the principles and practices of administration as they apply to the promotion and coordination of programs and services within behavioral health.
Understanding of diagnostic criteria and appropriate treatment approaches, clinical guidelines and best practices in the behavioral health field.
Excellent analytical skills.
Proficiency in the use of Microsoft Excel, Word and PowerPoint.
Excellent writing skills and ability to summarize reports in a concise and comprehensive manner.
Excellent communication skills to include presentation to large groups in a public forum.
Ability to maintain professional relationships with both internal and external staff.
A demonstrated ability to work cooperatively and communicate effectively, both within the Behavioral Health System and with a wide variety of individuals and agencies representing varying treatment perspectives.
Ability to work independently and operate with minimal supervision in an off-site location.
Ability to physically perform the duties and to work in the environment conditions required of the position.
Ability to interpret local, state, and federal laws, regulations, and ordinances.
This is a full time position in our office location in Philadelphia's historic district. In addition to a competitive salary and liberal benefit package (including but not limited to a 403(b) with 8% company match), we offer an opportunity for a dedicated professional to have an immediate impact in the lives of the people we serve.