House + Home Loans

IT Support

• Audits prescription claims to ensure compliance with 340B program
• Regular review of prescription program for 340B compliance
• Documentation and preparation for HRSA, Manufacturer or other audits
• Makes recommendations to pharmacy leadership regarding 340B audit findings
• Create and maintain provider file for all third-party administrators
• Create and provide quarterly Provider ID file
• Create, review and upload claims files for submission to manufacturer platform
• Create quarterly 340B compliance reports and monthly leadership reports
• Ensures pharmacy billing process and related duties comply with 340B regulations, CommUnityCare Standard Operating Procedures and CommUnityCare Policies and Procedures
• Participate in quality and compliance improvement activities such as the development of policies and procedures as it relates to 340B and Pharmacy Compliance
• Acts as backup to PBM Pharmacy Technicians including use of PBM platform for claims overrides

Pharmacy Technician – 340B Audit Specialist

Accounts Receivable

• Contact insurance carriers on a daily basis to follow up on/collect past due amounts on outstanding medical claims regarding denials or benefit changes
• Maintain an accurate, up to date aging of assigned accounts including AR analysis and follow up
• Keep educated on billing and medical policies for all payers
• Have a working knowledge of In and Out of Network reimbursement processes/methodologies
• Create and follow up on appeals needed to protest denials or incorrect payments
• Review complex denials/tasks assigned by the payment posting team and resolve accordingly including reviewing refund requests, disputes and appeal as necessary
• Work across all RCM departments to get issues related to claims payment resolved
• Uphold and ensure compliance and attention to all company policies and procedures as well as the overall mission and values of the organization
• Work with AR Supervisor to review/resolve open accounts as assigned
• Perform other duties as assigned

Accounts Receivable Specialist

Auditor

• Conduct coding audits, including prospective and retrospective chart reviews
• Communicate audit results and findings to providers
• Identify coding discrepancies and formulate suggestions for improvement
• Provide continuing education on coding

Senior Compliance Coding Auditor

Manager

• Conduct regular and targeted chart audits to ensure adherence to clinical guidelines, documentation standards, and payer requirements
• Lead clinical quality control programs aligned with The Joint Commission, HRSA, PCMH, and internal standards
• Evaluate care delivery against HEDIS and UDS measures, including immunizations, screenings, and chronic disease management
• Assist in preparing and coordinating external site visits and accreditation surveys
• Identify documentation gaps or patterns of concern and provide recommendations
• Maintain up-to-date knowledge of HRSA, Medicaid Managed Care, and other regulatory quality expectations
• Review and assess clinical documentation, care delivery processes, and interdisciplinary workflows for accuracy and integrity
• Maintain accurate records of quality reviews, audits, and corrective actions
• Monitor clinical data and patient outcomes to identify high-risk areas and trends
• Work with site leadership to develop, implement, and monitor corrective action plans
• Collect and analyze data to report identified trends, areas for improvement, and potential risks
• Assist in investigation of patient complaints, incidents, and adverse events; conduct root cause analysis and implement corrective actions
• Assist implementation of care initiatives aligned with value-based payment models (TCM, CCM, PCMH) and optimize workflows for payer incentive programs
• Develop and implement quality dashboards, indicators, and scorecards
• Deliver audit feedback and education to providers, nurses, and medical assistants to improve documentation and clinical care
• Develop training materials and conduct sessions on compliance, HEDIS/UDS reporting standards, and integrity
• Collaborate with QI teams, clinical directors, care coordinators, and health IT to ensure seamless quality data collection and use
• Serve as the nursing liaison in interdisciplinary quality teams and provide clinical oversight for performance improvement
• Support creation and implementation of quality control guidelines, policies, and procedures
• Analyze data and compile reports on quality indicators, trends, and performance metrics for committees and leadership

Nurse Manager, Clinical Integrity and Quality

Content Writer

• The Grant Writer is a key member of the Grants Management team and plays a vital role in leading the proposal preparation process for federal, state, local, and foundation funding opportunities
• Reporting to the Grants Manager, the Grant Writer supports the department in developing ready-to-deploy cases for support across key service lines that align with the agency’s strategic plan
• Conduct prospect research, develop and submit competitive grant proposals, letters of inquiry, and reports for government, foundation, and corporate funders
• Develop compelling narratives that effectively communicate the organization’s mission, programs, and impact
• Create and maintain cases for support by service line aligned with organizational priorities, community needs, and donor interests
• Track and manage submission deadlines and deliverables in collaboration with the grants team and program staff
• Identify and research new funding opportunities that align with organizational goals
• Support the grants management team in coordinating internal review processes, collecting programmatic data, and ensuring compliance with funder requirements
• Assist in preparing budgets and gathering necessary financial documentation for proposals and reports in coordination with finance staff
• Work cross-functionally with clinical, program, and administrative staff to gather information and develop funding narratives
• Support the grants management team with administrative functions necessary for recordkeeping and funding application eligibility

Grants Writer

• Manage referrals to CommUnityCare Addiction Recovery services, including buprenorphine treatment.
• Assess current needs of patients by conducting interviews with patients and/or family members to prioritize needs.
• Provide resources and actively support patient outreach and follow-through.
• Develop and implement individual treatment plans and update team on progress and barriers.
• Maintain knowledge of recovery resources and programs, including funding and insurance information.
• Collect detailed information from multiple resources to problem-solve complex patient issues.
• Advocate for clients in community settings (court, housing facilities, rehab, etc.).
• Determine healthcare coverage and assist with enrollment or maintenance of coverage.
• Provide outreach and coordination of care among local agencies and internal CommUnityCare providers.
• Assist patients with case management needs (medication access, transportation, medical beds, etc.).
• Provide brief crisis interventions as needed and participate in related planning committees.
• Complete all direct and indirect care documentation in a timely manner and attend daily huddles, meetings, and seminars.

Case Manager – Addiction Recovery

Risk

• Oversee patient safety, environment of care and risk management programs to ensure that patients receive the highest quality of care
• Guide site leadership in development of site-based safety programs that adhere to environment of care and OSHA standards
• Review and analyze reports of adverse events, near misses and concerns related to clinical risk and collaborate with departments and site leadership to develop responsive programs
• Conduct Root Cause Analysis (RCAs) on sentinel events and serious patient safety events as directed by the CMO or CRO
• Support the Director of Compliance in executing and implementing the annual compliance and risk work plan
• Develop and maintain policies and provide education related to implementation and revision
• Conduct internal audits in high-risk areas to assess quality of controls and prepare timely written reports of investigations and audits
• Serve as the organization’s Safety Officer and guide site teams on development and maintenance of environment of care and safety programs
• Assist Director of Compliance in coordinating Safety Committee activities
• Facilitate hazardous vulnerability assessments and annual emergency management and preparedness exercises
• Prepare reports and presentations; collaborate with cross-disciplinary teams and site leadership

Clinical Risk Manager

Therapist

• Treat injured, ill, or disabled pediatric patients through the therapeutic use of everyday activities.
• Help patients develop, recover, and improve skills needed for daily living and working.
• Develop and implement treatment plans outlining activities and specific goals.
• Implement programs involving manual arts and crafts, functional, prevocational, vocational, homemaking skills, activities of daily living, sensorimotor, educational, recreational, and social activities.
• Conduct physical and psychological assessments; observe patients doing tasks, ask questions, and review medical history.
• Evaluate patient condition and needs; evaluate home or workplace and recommend accommodations and improvements.
• Recommend and instruct on use of special/adaptive equipment (e.g., wheelchairs, eating aids).
• Assess and record patients’ activities and progress for evaluations, billing, and reporting to physicians and other healthcare providers.
• Advise on adaptive equipment and develop physical rehabilitation programs to help clients regain lost skills.
• Educate caregivers and family members on patient care and ensure continuation of therapeutic plan after discharge.
• Complete discharge planning in consultation with physicians, nurses, social workers; recommend outpatient or home health follow-up programs.
• Document patient care services in the medical record.
• Maintain safe and clean working environment; ensure operation and preventive maintenance of equipment.

Occupational Therapist, Pediatric

• Contact insurance carriers on a daily basis to follow up on/collect past due amounts on outstanding medical claims regarding denials or benefit changes
• Maintain an accurate, up to date aging of assigned accounts including AR analysis and follow up
• Keep educated on billing and medical policies for all payers; work knowledge of In and Out of Network reimbursement processes/methodologies
• Create and follow up on appeals needed to protest denials or incorrect payments
• Review complex denials/tasks assigned by the payment posting team and resolve accordingly including reviewing refund requests, disputes and appeal as necessary
• Work across all RCM departments to get issues related to claims payment resolved
• Work with AR Supervisor to review/resolve open accounts as assigned
• Uphold and ensure compliance with company policies and procedures as well as state and federal regulations; perform other duties as assigned