What are the responsibilities and job description for the Trainer and Compliance Specialist position at Community Resource Network of Florida, LLC.?
Community Resource Network of Florida is a premier provider of services to Individuals with Intellectual and Developmental Disabilities. We believe that all people should have access to services that enhance their lives and help them reach their personal goals.
We presently have an opening in our dynamic In-Home services division. This role will assist and support DSPs and families receiving services. This position requires a high level of customer service, attention to detail and the ability to work under tight timelines.
Fluency in Spanish and English is a requirement for this position.
Principal Accountabilities Of Position
Maintain standards of service delivery verification through the use of the required Electronic Visit Verification system (EVV). Responsible for collaboration with Individuals/families and Direct Support Professionals (DSP) to ensure compliance with Medicaid standards for verification parameters of in-home services.
ROLE OF THE COMPLIANCE SPECIALIST
The Compliance Specialist is responsible for daily tasks related to managing and updating the company’s EVV system and ensuring documentation compliance. The Compliance Specialist will interact with Direct Service Providers, Individuals and/or their families/guardians. Compliance Specialist will work closely with the In-home services team and the internal billing team. The Compliance Specialist will provide training and communication to those providing in-home services regarding best practices for EVV utilization.
Essential Functions
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We presently have an opening in our dynamic In-Home services division. This role will assist and support DSPs and families receiving services. This position requires a high level of customer service, attention to detail and the ability to work under tight timelines.
Fluency in Spanish and English is a requirement for this position.
Principal Accountabilities Of Position
Maintain standards of service delivery verification through the use of the required Electronic Visit Verification system (EVV). Responsible for collaboration with Individuals/families and Direct Support Professionals (DSP) to ensure compliance with Medicaid standards for verification parameters of in-home services.
ROLE OF THE COMPLIANCE SPECIALIST
The Compliance Specialist is responsible for daily tasks related to managing and updating the company’s EVV system and ensuring documentation compliance. The Compliance Specialist will interact with Direct Service Providers, Individuals and/or their families/guardians. Compliance Specialist will work closely with the In-home services team and the internal billing team. The Compliance Specialist will provide training and communication to those providing in-home services regarding best practices for EVV utilization.
Essential Functions
- System Monitoring:
- Daily monitor EVV systems to correct violations, such as missed punch ins/outs, no GPS signal, etc. so that service delivery can be verified
- Trouble shoot system errors with EVV system host. Work as a liaison between the DSP, and families to communicate utilization, correct errors and verify service
- Provide system updates and data entry support to correct errors so that the completed visits are eligible for billing
- Create Excel reports, and audits to reconcile data between multiple systems and determine error patterns, follow-up with DSPs/service providers
- Track support plan effective dates and maintain current plan for each Individual served
- Member
- Conduct spot checks and service verification on all services
- Make any requested changes to the member record in the EVV system
- Communicate EVV requirement guidelines to families receiving services
- Communicate changes to service delivery or required system updates
- Trouble shoot any problems, concerns, difficulties that families are experiencing with the system
- Provider (DSP)
- Provide education/training with providers to ensure their understanding of the system
- Contact DSPs for errors/corrections needed in the EVV system
- Communicate authorization changes and/or updates
- Ensure and verify understanding of service authorization parameters with DSP’s
- Maintain compliance standards in accordance with Florida Medicaid, ACHA, APD and other entities
- Audits Daily notes for content to ensure quality assurance and compliance with all requirements of AHCA, APD or other payers
- Provides coaching and training to DSPs on proper service documentation
- Monitors progress of documentation improvement
- Reviews documentation to mitigate fraudulent activity and adhere to Medicaid requirements
- Remains current with updates from AHCA, APD or other agencies in regard to documentation requirements
- Administrative Support
- Provide telephone support and in person visitors
- Create and maintain well-organized filing and retrieval systems
- Other projects and activities as assigned
- Document processes and support process updates to improve efficiencies
- Create correspondence as appropriate
- Retrieve and record notes regarding Individual’s concerns, medical updates or other changes to their care needs
- Maintains confidentiality in all communication; specifically protecting PHI of Individuals receiving services
- Utilization
- Communicate service authorization non-compliance issues to DSP, provide review and explanation of authorized services
- Communicate on-going compliance concerns
- Monitor entries for potential fraud to reduce incorrect billing
- Initiate fraud investigations with manager
- Communicate findings following fraud investigations to appropriate parties
- Provide documentation to appropriate parties if disciplinary action is determined as next steps of action following completion of investigation
- Work in collaboration with the billing department to initiate payback of fraudulent billings
- Attend meetings and communicate frequently with the team
- Provide receptionist support to in-person and telephone callers
- Document processes
- Create correspondence as appropriate
- Other projects and activities as assigned
- Primary activities are conducted within a well-lit, climate-controlled facility
- This role routinely uses standard office equipment such as computers, phones, photocopiers, printers, filing cabinets and fax machines
- Occasional trips to client/prospect locations require outdoor travel and potential exposure to unpleasant weather
- Ability to bend, stand, walk or sit for extended periods of time and possess the normal range of body motion
- Travel to other company locations as required
- While performing the duties of this job, the employee will be occasionally required to stand, walk, sit, use hands to finger, handle, or feel objects, tools, or controls, reach with hands and arms, climb stairs, balance, stoop, kneel, crouch or crawl; talk or hear; taste or smell
- Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to focus
- Ability to regularly lift or move up to 25 pounds independently
- Periodic exposure to bodily fluids, and other pathogens
- Noise levels vary in the work environment
- High School diploma or equivalent
- Min. 1- year direct customer service, via telephone or face-to-face
- Valid state driver’s license
- Must pass Level II Background screening
- Bi-lingual skills required: Spanish and English
- Understanding of general business, office terminology and intermediate computer skills
- Thorough understanding of the MS Office Suite products/programs
- “Company Knowledge” Understand and articulate the services provided and the customer value for the CRN brand
- Strong interpersonal and communication skills (both verbal and written)
- Excellent customer service skills
- Compose routine correspondence and reports
- Plan, organize and prioritize work, as well as work under tight timelines
- Work independently while communicating and coordinating work efforts with other employees and organizations
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