Location: Indianapolis, IN

Hours: M – F

Travel: Field Based Role (25% - 50% in state travel)

Position Overview:

The LTSS Provider Auditor is a part of the LTSS PR team, supporting quality in service delivery. The LTSS Provider Auditor is responsible for quality oversight and ensuring LTSS Providers are in compliance with federal state laws, and internal policies related to LTSS/HCBS service delivery.

How You Will Make an Impact:

• Leads day-to-day activities related to LTSS provider performance and compliance monitoring, ensuring adherence to contractual and federal requirements specific to HCBS providers.

• Operates as the Subject Matter Expert as it pertains to LTSS provider compliance requirements and oversight and LTSS Benefits.

• Working in alignment with the LTSS PR Rep, conducts audits and onsite reviews supporting contractual requirements.

• Reviews policies and procedures to support contractual compliance for provider programs.

• Conducts provider meetings to discuss audit findings and review action plans to ensure providers can come into compliance with health plan expectations, contractual and federal requirements.

• Selects providers to be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider

• Schedules review with provider, analyzes data to select claims to be reviewed, conducts review using medical charts, medical notes, itemized bills and provider contracts

• Conducts exit interview with provider management team by presenting preliminary review results

• Verifies dollar amount on claim is correct in claims system and writes report of the findings of the review and requests payments for any overpayments

• Identifies aberrant patterns of billing and detects potential abuse

• Participates in developing and/or reviewing department policies and procedures

• Works on task forces and committees

Required Qualifications:

• Requires either a BA/BS degree, medical coding certification and a minimum of 2 years’ relevant work experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications:

• Experience coordinating projects preferred

• Provider Quality oversight experience preferred

• Experience with MS Office, particularly PowerPoint and Excel

• Strong Medicaid LTSS experience

• Knowledge of state and federal requirements impacting LTSS providers, including but not limited to Person Centered Planning, HCBS Settings Rule, Electronic Visit Verification.

• Experience with home health, personal care, hospice, nursing facilities, and/or assisted living providers preferred