Quality Assurance and Compliance Manager

Remote Opportunity with a Flexible Schedule Employer: TRAC Autism Center Inc. Office location: 3290 W Big Beaver Rd, Troy, MI 48084, United States. Work arrangement: Remote. Schedule: Create your own schedule, Monday through Friday, within a 40-hour workweek. Reports directly to: Director of Operations and VP of Clinical Operations. About the Opportunity TRAC Autism Center Inc. is looking for an organized, approachable Quality Assurance and Compliance Manager who enjoys helping teams stay on track and making it easier for families to access Applied Behavior Analysis (ABA) services. In this role, you will manage quality assurance, compliance, provider credentialing, client intake, benefits verification, and service authorizations, working closely with our operations and clinical leaders. This remote position offers the flexibility to create your own schedule within a 40-hour workweek, Monday through Friday. You will have room to organize your day while staying connected with the team, meeting payer and compliance deadlines, and keeping important processes moving. We are looking for someone who brings practical ABA or behavioral health experience, follows through on details, and takes a collaborative approach to solving problems. What You Will Do Provider Credentialing and Enrollment Manage provider credentialing, renewals, and enrollment for TRAC, its service locations, and individual practitioners across county Community Mental Health (CMH) agencies, Community Mental Health Services Programs (CMHSPs), regional Prepaid Inpatient Health Plans (PIHPs), Medicaid, and commercial insurance networks, as applicable. Keep an organized reference of county and payer requirements, including provider qualifications, application steps, contract conditions, and renewal deadlines. Prepare credentialing and enrollment applications, follow up on missing information, and track submissions, approvals, and participation effective dates. Keep CAQH Provider Data Portal profiles, Michigan CHAMPS records, NPI/NPPES information, payer portals, and county or regional profiles current. Coordinate provider attestations and access in accordance with each portal’s requirements. Maintain accurate provider rosters and supporting records, including practice affiliations, service locations, licenses, certifications, and professional liability coverage. Work with human resources and clinical leadership to verify licenses, BACB certifications, provider qualifications, exclusion screening, and required training records. Confirm that provider participation and payer billing requirements are in place before services are assigned or claims are submitted. Be the main administrative contact for credentialing and enrollment questions. Work with county and payer contacts to resolve issues and keep leadership informed of delays that could affect services or reimbursement. Client Intake Benefits and Authorizations Guide families through the administrative intake process by sending intake packets, collecting and processing completed forms and supporting documents, checking for completeness, and following up on missing information. Keep intake records up to date and share timely updates with the VP of Clinical Operations on prospective client progress and outstanding intake needs for new and current clients. Complete timely insurance eligibility and ABA benefits checks for prospective clients, clients preparing to start services, and current clients. Record coverage dates, benefits, authorization requirements, and any coverage limitations or changes. Prepare, submit, and process ABA authorization requests, renewals, and changes, working with the clinical team to gather the necessary clinical documentation. Follow authorization requests through to a decision, follow up with payers, and keep the VP of Clinical Operations and relevant teams informed of approvals, denials, delays, and upcoming expirations. Keep clear authorization records, including approved services, authorization numbers, coverage periods, approved units, units used, and remaining balances. Track authorization units and utilization with the VP of Clinical Operations. Work with scheduling and billing to address discrepancies, approaching unit limits, underutilization, and renewal needs before they affect services or reimbursement. Compliance and Policy Support Maintain a practical compliance work plan and process for identifying risks related to federal and Michigan requirements, Medicaid rules, county and payer contracts, privacy and security, recipient rights, and applicable ABA ethical standards. Work with the Director of Operations and department leaders to review and update policies and procedures so they are current and easy for staff to follow. Keep compliance deadlines and document versions organized, and turn regulatory or payer updates into clear guidance for the team. Coordinate HIPAA privacy and security activities with designated privacy, security, and IT personnel, including system access, information sharing, record retention, and incident response. Maintain confidential ways for staff to raise concerns and help leadership and counsel, as appropriate, review and document potential violations, credentialing discrepancies, conflicts of interest, or suspected fraud. Bring significant compliance concerns to leadership promptly and help coordinate the necessary response. Quality Assurance and Record Reviews Organize regular audits of client records, personnel files, credentialing records, and administrative processes, using consistent checklists and prioritizing areas with greater risk. Partner with the VP of Clinical Operations and clinical leaders to address documentation gaps, agree on corrective steps, and follow through on resolution. Look for patterns in audit results, incidents, family feedback, and daily workflows. Recommend practical improvements and check that they are working. Work with clinical operations to review safety incidents, grievances, and adverse events, understand contributing causes, and develop corrective and preventive actions. Billing Coordination and Audit Readiness Work with billing, intake, scheduling, and clinical teams to confirm that services, authorizations, provider eligibility, documentation, and claims are consistent. Review applicable ABA coding, modifiers, units, service limits, supervision, and payer billing requirements, and work with the appropriate teams to resolve discrepancies. Coordinate county reviews, payer audits, regulatory inquiries, and accreditation reviews when applicable, keeping supporting records organized and responses on time. Track audit findings, follow-up responsibilities, corrective action deadlines, and completed resolutions. Support repayment or disclosure processes when needed and directed by leadership. Team Collaboration Training and Reporting Coordinate staff education with human resources and department leaders on credentialing, documentation, privacy, recipient rights, reporting responsibilities, and policy updates. Keep compliance training records current and work with human resources and leadership to track completion and renewal deadlines. Share clear updates with leadership on credentialing, intake, benefits issues, authorizations, unit utilization, audit results, outstanding documentation, corrective actions, recurring incidents, and key risks. Help lead improvements across departments, clarify who is responsible for follow-up, and supervise assigned quality assurance or credentialing staff, if applicable. Build positive working relationships with staff, families, county representatives, and payers while handling sensitive information carefully and reviewing concerns fairly. What You Bring A bachelor’s degree in healthcare administration, business administration, public health, psychology, behavioral health, or a related field. An equivalent combination of relevant education and substantial professional experience may also be considered. At least three years of relevant healthcare or behavioral health experience in quality assurance, compliance, credentialing, or provider enrollment, including direct experience supporting ABA services. Hands‑on experience with provider credentialing across multiple county CMH/CMHSP or regional PIHP networks, including applications, renewals, supporting documents, and follow‑up. Experience keeping online provider profiles and enrollment records current, including CAQH, payer portals, and county or regional systems, plus working knowledge of Michigan CHAMPS or a comparable Medicaid enrollment system. A working understanding of ABA documentation, provider qualifications, and payer requirements. Practical experience with client intake, insurance eligibility and benefits checks, ABA authorization requests, and tracking authorization units and utilization with clinical leadership. Experience reviewing records or conducting audits, identifying compliance gaps, and helping teams complete corrective actions. Knowledge of HIPAA, healthcare confidentiality, Medicaid compliance, recipient rights, and fraud, waste, and abuse prevention as they relate to this work. An organized, dependable approach, clear communication, and comfort balancing deadlines, handling confidential information, and working through concerns with others. Comfort using electronic health records, practice management systems, Microsoft Office or similar tools, and spreadsheets for tracking and reporting. Helpful Additional Experience Five or more years of experience in ABA or behavioral health compliance, quality assurance, or credentialing, especially with team leadership or program management. Familiarity with ABA compliance, documentation, credentialing, or provider network requirements in Ottawa, Genesee, Shiawassee, and Oakland counties, including work with their CMH agencies or regional PIHP networks. Experience with payer audits, Medicaid documentation reviews, accreditation preparation, or building a compliance program. A relevant certification, such as Certified in Healthcare Compliance (CHC), Certified Professional in Healthcare Quality (CPHQ), or Certified Provider Credentialing Specialist (CPCS). A master’s degree in a related field or relevant ABA certification or licensure. BCBA certification can be helpful for clinical collaboration but is not required for this administrative management role. Remote Work and Scheduling Flexibility You can work remotely and create your own schedule within a 40-hour workweek, Monday through Friday. The role calls for dependable communication, coordination with colleagues and external contacts, and timely completion of intake, authorization, credentialing, and compliance work. It involves regular computer use and confidential record review. Attendance at audits or external meetings may occasionally be needed based on TRAC’s service locations. Essential functions may be performed with reasonable accommodation. TRAC Autism Center Inc. is an equal opportunity employer. Qualified applicants will be considered without regard to any status protected by applicable law. Reasonable accommodation is available during the application process and in the performance of essential job functions. #J-18808-Ljbffr HR Alliance