Provider Network Auditing Supervisor

Under general supervision of the Manager of Network Services and Supports, responsible for supervising the provider network services auditing program of the Saginaw County Community Mental Health Authority (SCCMHA). The auditing unit is responsible for part of a compliance and quality performance program to safeguard against fraudulent or erroneous claims of persons served service provision and is a primary source of the required monitoring of provider performance on behalf of SCCMHA. Oversight of audit functions includes both contracted and SCCMHA operated services and program units that provide direct services to persons served. The position develops and refines audit tools and processes that meet SCCMHA contractual and legal obligations by source reference. The position ensures proper and professional documentation and appropriate routine communications of provider monitoring and event verification functions as well as integrity and consistency in the audit process, measures, and data. Provides analysis and summary data to the SCCMHA management team on audit outcomes as planned or requested. Coordinates unit functions with contract management, training, and recipient-rights areas, as well as other programs or units of SCCMHA as indicated. This position also oversees the aspects of Home and Community Based Services Rules This position will be knowledgeable about and actively support culturally competent recovery based practices; person centered planning as a shared decision making process with the individual, who defines his/her life goals and is assisted in developing a unique path toward those goals; and a trauma informed culture of safety to aid persons served in the recovery process.

Education: Bachelor’s degree in social work, psychology, or closely related Human Services field and knowledge of health care administration, or a Bachelor’s in a business-related area, with specific program or financial auditing experience. A Master’s degree is preferred.

Experience: A minimum of five (5) years of experience in health care, business or related financial or program field is required; although clinical experience is helpful, experience must include some business-related functions. Audit and/or data analysis experience preferred. Human service experience and/or knowledge preferred. Business, finance, and computer skills, including spread sheet functions, are required. A general knowledge of mental health systems, and compliance or medical records desired. Must be able to provide samples of varied, quality written work.

Licenses and Certifications: Valid Michigan Driver’s license with a good driving record.

Works in normal office environment with usual pressures of dealing with time constraints. Works as a supervisor of an audit team/unit and department member. Because of multiple provider sites of SCCMHA and the need to visit some programs on site, it is common to drive to several locations, sometimes in bad weather