GLO - Contract Administration Manager I

Complete in-person therapy compliance reviews at each Texas State Veterans Home at least once per fiscal year, and more frequently for homes with elevated billing, documentation, utilization, or compliance risk.

Reviews should include record sampling, therapy department interviews, invoice-support review, documentation workflow review, and exit discussions with the Operator.

• Spot Checks and Outlier Monitoring

Perform routine spot checks and utilization monitoring to identify unusual therapy patterns, including high therapy minutes, extended treatment duration, repeated recertifications, duplicate billing, therapy during hospitalization, lack of measurable progress, or materially different utilization among homes or contractors. Identified concerns must be documented and escalated according to VLB procedures.

Prepare and submit a quarterly therapy compliance report to executive leadership within 15 business days after the end of each quarter.

The report must summarize therapy spend, utilization trends, SCD-70 therapy volume, review results, questioned costs, recoveries or avoided costs, contractor performance concerns, and recommended policy or contract actions.

• Operator Guidance, Corrective Action, and Program Improvement

Develop and maintain written therapy documentation standards, review tools, and training materials for Operators and therapy contractors, and provide technical guidance when recurring deficiencies are identified.

For material or repeated noncompliance, recommend corrective action, payment denial, recoupment, or contract escalation consistent with VLB¿s records access rights under the contract.

• Bachelor's degree from an accredited institution.
• Five years of work experience in contract compliance, audit, utilization review, quality assurance, or a related field.
• Experience and education may be substituted for one another.

• Currently licensed in Texas as a physical therapist, occupational therapist, or similar. Related military occupational specialty may be considered in lieu of state licensure.
• Experience in Skilled Nursing Facility therapy documentation.
• Experience in Medicaid and/or Medicare compliance.

• Knowledge of therapy plans of care, treatment minutes, medical necessity, skilled maintenance therapy, restorative therapy, and discharge planning.
• Skill in the use of a computer and applicable software.
• Skill in problem solving and analyzing information.
• Ability to interpret laws, rules, and regulations applicable to therapy-related claims and services.
• Ability to review clinical records, identify unsupported claims, and communicate findings clearly.

This position requires the employee to primarily perform sedentary office work; however, mobility (moving around the worksite) is routinely required to carry out some duties.

This position requires extensive computer, telephone and client/ customer contact and communication.

It requires the ability to move and position oneself as needed for filing and similar routine office duties.

The job also requires normal cognitive abilities requiring the ability to learn, recall, and apply certain practices and policies.

It requires the stamina to maintain attention to detail despite interruptions.

Ability to read printed materials and computer screens.

The individual must be able to move and transport records, documents, boxes, and all related information and materials, weighing up to 20 pounds when required.

• Free Parking
• Defined Retirement Benefit Plan, Optional 401(k) and 457 accounts
• Medical Insurance - The State pays 100% of the health plan premium for eligible full-time employees and 50% of the premium for their eligible dependents. The State pays 50% of the eligible part-time employees¿ premiums and 25% for eligible dependents
• Optional Benefits such as dental, vision, and life insurance.
• Minimum of 96+ Hours of Annual Leave a year **Annual leave increases with length of service.
• Professional Development Opportunities: The GLO offers numerous courses to help our employees grow using resources through LinkedIn Learning and our EAP provider.

Veterans: Use your military skills to qualify for this position or other jobs!

Go to www.texasskillstowork.com to translate your military work experience and training courses into civilian job terms, qualifications, and skill sets.

Also, you can compare this position to military occupations (MOS) at the Texas State Auditor's Office by pasting this link into your browser: Property Management and Procurement .

To be considered, please complete a State of Texas Application for Employment and apply online at www.workintexas.com or in the CAPPS Career Section .

You may apply for the job directly through the CAPPS Career Section.

It is not necessary to apply both through Work in Texas and the CAPPS Career Section.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

A position utilizing this classification will be designated as security-sensitive according to the Texas Labor Code, Section 301.042.

Applicants must be authorized to work for ANY employer in the U.S.

We are unable to sponsor or take over sponsorship of an employment Visa.

Applications must be fully completed with a detailed job history, including job title, employment dates, employer¿s name, supervisor's name and phone number, and summary of responsibilities.

Incomplete applications may lead to disqualification.

Please be aware that resumes will not be accepted in place of a completed application.