Therapy Provider Network Compliance Specialist

OVERVIEW OF POSITION:
Under limited supervision, the Compliance Auditor conducts routine audits to ensure the accuracy of coding and
the sufficiency of associated provider documentation, maintaining best practice compliance standards. The
auditor performs on-site and off-site pre- or post-charge audits on participant accounts to determine coding
accuracy. Additionally, the auditor reviews files and charts in clinics to ensure the healthcare facility complies
with standards established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), as
well as federal Medicare/Medicaid programs, state programs, and the facility's established criteria.

Salary: $97k-110k

ESSENTIAL FUNCTIONS:
 Audit, monitor, and oversee therapy service providers: Conduct thorough audits of occupational therapy,
physical therapy, and speech-language pathology service providers to ensure compliance with National
Committee for Quality Assurance (NCQA) standards and Credentialing and Re-credentialing requirements
(CR 11). This includes evaluating administrative management practices, emergency plans,
accommodations, physical facility conditions, and medical record-keeping practices.
 Travel for compliance audits: Utilize a personal vehicle to travel to Therapy Centers and contracted therapy
providers to conduct on-site audits. Ensure that these providers adhere to established compliance
standards and regulations.
 Develop and manage performance improvement plans: Create, monitor, and manage performance
improvement plans for network providers based on audit findings. Work collaboratively with providers to
implement necessary changes and improvements.
 Oversee organizational security and confidentiality: Audit and monitor the security, confidentiality, and
access to medical records within the organization. Ensure that all practices comply with relevant
regulations and standards.
 Provide quarterly status reports: Prepare and present detailed quarterly status reports to the Director of
Therapy Provider Network, Regional Vice President, and Vice President of Therapy Services. These reports
should include audit findings, compliance status, and recommendations for improvement.
 Document and address concerns: Record and follow up on any concerns or grievances related to the
delivery of therapy services. Ensure that issues are resolved promptly and effectively.
 Conduct initial assessments: Perform initial assessments for participants referred for Occupational Therapy
services, which will constitute 25% of the productivity component. Ensure that assessments are thorough
and meet established standards.
 Perform other duties as assigned: Carry out additional tasks and responsibilities as required to support the
overall compliance and auditing functions of the organization.

EDUCATION:
 Master’s degree required in Occupational Therapy.
 A valid (California) license to practice in the incumbents respective discipline,
 Must be a licensed Occupational Therapist
 Current board certification as required.

EXPERIENCE:
 3 to 4 years’ experience in the delivery of occupational therapy with individuals diagnosed with Autism.

KNOWLEDGE, SKILLS, ABILITIES:
 Strong communication skills, both orally and written.
 Assignments are received in the form of results expected but incumbent has considerable freedom to
decide on work priorities and procedures to be followed.