Experience

Kansas Health Solutions, LLC

• United States
• Mental Health Care
• 1 - 100 Employee

• Compliance Analyst

  • Oct 2009 - Present

  • Ensured mental health services are delivered in a manner reflecting compliance with statutes, regulations, and contractual obligations. • Monitored Kansas Mental Health Providers to ensure medical necessity of services provided, appropriate utilization of treatment resources, and accurate claims submission. • Planned and coordinated routine audits on a scheduled basis to monitor for compliance with requirements associated with Title XIX and HCBS Waiver programs to include documentation practices and other requirements identified by Kansas Health Solutions. These audits include Claims Verification Audits, Coordination of Benefits/Third Party Liability Audits, and Post Discharge Access Audits. • Performed more focused audits in the event a concern has been identified which may suggest possible abusive or fraudulent activity. Emphasis on accurate claims submission practices, documentation requirements, procedural issues, compliance with Federal and State regulations, and comprehensive analysis of multiple concerns to determine possibility of waste, fraud or abuse. • Developed reports of audit findings, develop auditing tools and instruments, and perform data analysis. • Managed and organized appeals of Routine/Focused audits. • Researched federal and state regulations, CPT and HCPCS requirements, and diagnostic recourse manuals. • Tracked and identified trends within claim submission data. • Compiled data for appeals, state fair hearings, subpoenas, and record requests. Show less



Valeo Behavioral Healthcare

• Homeless Outreach Specialist/Case Manager

  • Sep 1999 - Oct 2009

  • Assisted homeless adults with severe and persistent mental illness in working towards improvements in the following daily living areas: Housing, medication education, life domains, financial/insurance, vocation/educational, social supports, health, integrated dual diagnostic treatment, and leisure/recreational support. • Developed and executed community presentations. • Networked with surrounding community agencies. • Organized assertive outreach expeditions in order to connect with homeless individuals in the community and arrange for appropriate services through local agencies. Show less