Compliance and Credentialing Associate - BOSTON PUBLIC HEALTH COMMISSION : Job Details

The Compliance and Credentialing Associate reports to the Compliance and Credentialing Specialist. This position is responsible for identifying and addressing potential regulatory issues to the Compliance and Credentialing Specialist. Compliance program activities include advising, training, independent testing & monitoring, reporting, escalation, and oversight to the LCSW, LICSW, LADAC and other clinicians. The Associate will be facilitating successful maintenance of Clinicians by performing ongoing monitoring processes of all required program clinicians in accordance with industry and contractual standards.

• Maintains a communication tracking spreadsheet for the credentialing and compliance program
• Assists Manager with the maintenance logs for confidential reporting, and investigation of compliance
• Coordinates with the Compliance and Credentialing Specialist in response to identified compliance questions, quality assurance concerns, or federal/state inquiries or
• Assist Supervisor with efforts to communicate credentialing and compliance program protocols, including written materials and training programs designed specifically to promote understanding of compliance issues, laws and regulations, and consequences of non-compliance.
• Utilizes available resources; attend seminars and training programs, develop peer contacts, and research various industry information resources (i.e., Internet sites, newsletters, ) as necessary.
• Assist Manager with maintaining a consistent management reporting process that provides timely and relevant information on all aspects of compliance, quality assurance and credentialing issues.
• Reviews reported issues, concerns, or questions related to compliance and credentialing matters and presents to Manager for review.
• In coordination with the Compliance and Credentialing Specialist, provide a timely response, and participates in compliance investigations, including maintaining the confidentiality of information reported by individuals in order to protect both the individual and the subject of the investigation. Meets regularly with program director(s) regarding program finance needs.
• Use independent judgment and discretion to make recommendations to Revenue Department management on issues that impact the program and staff as it relates to program operations/services and BPHC
• Maintains a working knowledge of Medicaid Time Study for the Health Baby Health Child program and medical insurance as it relates to third party billing.
• Assists with Carelogic System maintenance as needed.
• Performs other duties as required by management.

• BA/BS in Finance, Accounting, Business, Economics, or related field required or;
• Associate Degree in Finance, Accounting, Business, Economics, or related field and 1 year of transferable Accounting or Third-Party experience or;
• 1-2 years of transferable Accounting or Third-Party experience may be substituted in lieu of degree.
• Plus at least 1 year of transferable Accounting or Third-Party experience is required.
• Prior experience working with a nonprofit or a city/municipal agency is preferred.