Contracts and Audit Specialist

Responsibilities

• Ensure provider contracts are compliant with current state and federal requirements.
• Complete and document corrective actions assigned to the Care Management Division.
• Aid in Care Management Division operations by obtaining necessary letters of agreement (LOA) with non-contracted providers when needed medical services are not readily available in the AHF’s provider networks.
• Ensure compliance with ever-changing state and federal regulations and contracting documents, including accuracy and currency of provider recruitment materials.
• Keep AHF up-to-date with all contracting documents and templates.
• In collaboration with AHF’s IT Department, validate that provider network data submissions are error-free to ensure compliance with state and federal network adequacy requirements and enrollee and primary care provider satisfaction.