Project UM Audit & Documentation Director

Overview

Project UM Audit & Documentation Director

 

Location: 100% travel - Remote

 

 

The Project Utilization and Documentation Director supports UM Leaders and their department operations at assigned facilities, ensuring medical necessity, compliance, and financial performance. This role utilizes Behavioral Health treatment and medical necessity expertise, payer audit readiness, and documentation excellence to optimize reimbursement at facilities in collaboration with facility leaders and corporate partners.  This employee will be responsible for providing expert guidance and advice on all aspects of clinical documentation integrity, clinical protocols, and payor reimbursement and payor audit compliance in Acadia facilities.

 

This position involves up to 100% travel to support assigned facilities and may include evenings and weekends based on need.

 

Our Mission

Acadia Healthcare’s purpose is to Lead Care With Light and our mission is to be a world-class organization that sets the standard for excellence in the treatment of mental health and addiction concerns. We strive to maintain our standing as a thought leader in the behavioral healthcare industry, providing treatment that is synonymous with compassion and innovation.

  

Compensation & Benefits

We value your expertise and dedication—and we invest in your success.

• Competitive Base Salary commensurate with experience
• Bonus eligible
• Comprehensive Medical, Dental, and Vision Insurance
• 401(k) Plan with Company Match
• Paid Time Off (PTO) and recognized holidays
• Company-paid Basic Life and AD&D Insurance
• Employee Assistance Program (EAP) and mental wellness resources
• Opportunities for professional growth and advancement within Acadia’s nationwide network

 

Responsibilities

Essential Functions

• Provides on-site leadership to assess and analyze current Intake and Utilization processes, challenges and outcomes; including compliance and regulatory requirements are met
• Audit patient charts at assigned facilities to ensure accuracy, completeness, and compliance with regulatory standards and practice guidelines. Identify discrepancies or missing information and take corrective action with team members providing care at the facility.
• Performs facility audits of clinical and financial information related to denial management including length of stay, medical necessity documentation, precertification, concurrent authorizations, compliance with Medicare Certification/Recertification, Medicare Internal Audits, and compliance with EMTALA standards
• Ensure that all records and documentation practices comply with HIPAA regulations and other relevant healthcare laws and standards. Participate in internal audits and implement corrective actions as needed
• Conduct regular quality checks on medical records and scanned documents to maintain high standards of accuracy and completeness. Report any issues or concerns in real-time to care providers and clinical leaders at the facility.
• Generate and maintain reports on chart audits, compliance issues, and other relevant data. Provide insights and recommendations to improve record-keeping processes and documentation practices.
• Serves as resource for education and training to physicians and clinical staff on current documentation and regulations
• Support the development and sustainment of action plans for the resolution of problematic issues or to address areas of compliance vulnerability
• Assist in the development of Process Improvement practices in facilities and maintenance of same including analysis of data and prioritization of efforts as needed
• Collaborates with clinical services to ensure clinical documentation provides rationale to ensure authorization is obtained via successful process and utilization of the patient’s individualized benefit is achieved
• Provides consultation and guidance regarding written level of care guidelines for a variety of payors
• Provides consultation and guidance regarding the appeal process. Assists facility UM staff in creating effective appeal letters
• Ensures proper use of Medhost, the Medhost dashboard, and Sharepoint.
• Maintains current knowledge of applicable regulations and regulatory update in the behavioral health field
• Performs other duties as assigned

 

Standard Expectations

• Complies with organizational policies, procedures, performance improvement initiatives and maintains