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Internal Auditor
Tri-County Human Services, Inc.. Review service documentation and provide technical assistance and expertise related to private insurance, ADM, CFBHN, and Medicaid .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicaid and private insurance documentation and billing procedures, with a strong focus on quality management and compliance. Capable of training staff on documentation standards and conducting audits to ensure adherence to agency policies.
Highest-signal resume keywords
Medicaid DocumentationPrivate Insurance BillingClinical Documentation ReviewLCSW LicenseOrganizational Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Audit ProceduresData EntryQuality ManagementDocumentation StandardsBilling Procedures
Soft Skills
Strong Organizational Skills
Tools & Technologies
Electronic Health Record System
Certifications & Qualifications
LCSW LicenseLMHC License
Industry Keywords
Behavioral HealthComplianceTANFPPWDCCFBHN
About the role
Key responsibilities & impact- Review service documentation and provide technical assistance and expertise related to private insurance, ADM, CFBHN, and Medicaid
- Review randomly selected electronic health records to determine effective utilization and quality management of services
- Enter audit results into the electronic health record system for tracking and analysis
- Coordinate with staff completing documentation and data entry to coordinate billing and ensure compliance with agency policy
- Review clinical records to identify billable services that do not meet insurance documentation requirements
- Advise Program Supervisors and unit staff regarding billing opportunities, missed opportunities, and required documentation
- Provide audit findings to facility supervisors and administrative staff and follow up on corrections
- Maintain current knowledge of Medicaid, PPWDC, TANF, FIS, CFBHN, and private insurance documentation and billing requirements
- Provide ongoing education to staff regarding documentation standards and guidelines
- Train assigned support staff on billing and audit procedures
- Recommend follow-up actions, including potential disciplinary action, in consultation with the Compliance Director
- Assist the compliance department with reviewing, developing, and updating policies and procedures
- Perform other assigned duties
Requirements
What you’ll need- Bachelor’s degree in behavioral health or another related field required
- Master’s degree preferred
- LCSW or LMHC license preferred
- Computer operation skills
- Knowledge of Medicaid/private insurance, clinical documentation, and billing procedures
- Strong organizational skills
- At least two (2) years of full-time experience in a setting where the relevant knowledge and skills were utilized
- Capability to monitor quality documentation and service utilization trends
Benefits
Comp & perks- Short- and long-term telecommuting per policy 100.027 – Telecommuting Guidelines
- Attendance at workshops and/or consultation with designated administrative staff for maintaining billing and documentation knowledge