Contract Compliance, Audit, & Reporting Specialist

Responsibilities

• Monitor contracted service provider and funder requirements for compliance, including CCBHC DCOs and other contracted service provider requirements.
• Lead audit and reporting activities to monitor compliance with requirements, metric expectations, corrective actions, and compliance across DCO and contracted network providers.
• Collaborate closely with Contract Management, Quality Assurance, Program Leadership, Corporate Compliance, and contracted network providers and partners to ensure required standards are met and sustained.
• Serve as a liaison between the organization and contracted network providers, supporting effective oversight, communication, and continuous quality improvement.
• Ensure timely monitoring, documentation, reporting, and follow-up related to provider performance, contract requirements, and compliance expectations.
• Audit administration: Create and maintain the audit schedule, track deadlines, organize records, assign follow-up tasks, and ensure audits are completed on time and documented consistently.
• Periodic audits: Schedule and perform regular audits to confirm that contracted service provider programs, including required processes and procedures, are meeting required standards.
• Credentialing audits: Verify that contracted service providers meet required qualifications, licenses, certifications, training, and enrollment standards.
• Administrative may audits: Conduct desk audits to examine records, reports, attestations, and other evidence to determine whether contracted service providers are meeting expectations.
• Training compliance monitoring: Ensure required trainings are completed, tracked, and kept up to date for contracted service providers.
• Attestations: Monitor required attestations to ensure they are collected on time, completed properly, and supported by documentation when needed.
• Policies and procedures compliance: Verify that contracted service providers are following contract requirements, including policies and procedures.
• MIChoice and other regulatory reporting: Support activities related to MiChoice funder and regulatory requirements.
• Collaborate with the Reporting and Business Intelligence (RBI) Team to develop management reports and monitoring tools.
• FWA monitoring: Identify patterns or behaviors that could create legal, financial, or ethical risk, such as billing irregularities, improper documentation, duplicate services, or suspicious referral patterns.
• Conflict monitoring: Identify situations that could create conflicts of interest, referral concerns, self-dealing, or other relationship-based risks.
• Contracted Service Provider PIP/CAP follow-up: Review and follow-up of Performance Improvement Plans and Corrective Action Plans.
• CCBHC DCO Compliance Monitoring: Ensure that Certified Community Behavioral Health Clinic DCO requirements are met, including required training, evidence-based practice, credentialing, and staffing expectations in alignment with CCBHC requirements.
• Quality alignment: Help ensure that contracted service provider auditing and compliance activities align with broader quality goals and expectations.
• Reporting to Corporate Compliance: Share findings, trends, risks, and follow-up actions with the Corporate Compliance team.

Qualifications

Strong organizational skills and attention to detail are essential. Proficiency in Microsoft Office Suite, particularly Excel and Word, is required. Familiarity with healthcare regulations and compliance standards is necessary. Experience with auditing and reporting processes is preferred. Bachelor's degree in a relevant field (e.g., Healthcare Administration, Public Health, Social Work) is required. Minimum of 3 years of experience in healthcare compliance or related field is preferred. Excellent communication and interpersonal skills are required. Ability to work independently and manage multiple projects simultaneously is essential. Knowledge of Medicaid and Medicare regulations is beneficial.