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Applied Behavioral Analysis Review Analyst (BCaBA/QASP)

Company: Centene
Location: Rancho Cordova
Posted on: March 17, 2020

Job Description:

Applied Behavioral Analysis Review Analyst (BCaBA/QASP) Position Purpose: Audit ABA claims by reviewing claims and medical records and researching program requirements, clinical guidelines, licensing board requirements and professional practices Draft, review, submit and track targeted educational letters and other materials addressing audit findings and other concerns Track and report audit results, education efforts, and other activities Ensure all case documentation is updated in the STARS anti-fraud system Assist with the development, review and update of standard operating procedures and other adhoc requests related to the Program as needed Interpret ABA claims, review medical records, and interpret medical policies to identify improper payments. Educate and advise staff on proper billing requirements, mitigate the impact of billing aberrancies to the program, triage reported fraud waste and abuse cases within the Applied Behavioral Analysis (ABA) program. Analyze and make determination of appropriate course of action for cases. . Assist Program Integrity Investigators with Health Care Fraud Referrals concerning ABA providers. Assist in the development of policies, procedures, and educational materials to prevent loss of company assets. Education/Experience: Bachelor's degree in Healthcare or related field. 2+ years of clinical experience and claims submission or claims review / audit experience. Medical record and claims billing knowledge. Medical record and billing experience preferred. Clinical knowledge of applied behavioral analysis and autism treatment practices. License/Certification: Board Certified Assistant Behavior Analyst (BCaBA) This position will be supporting a Federal government contract, therefore it requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Clinical & Nursing USA-California-Rancho Cordova Federal Services Full-time

Keywords: Centene, Rancho Cordova , Applied Behavioral Analysis Review Analyst (BCaBA/QASP), Professions , Rancho Cordova, California

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