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Full Job Description
TITLE: Quality Assurance Coordinator, Behavioral Health
RESPONSIBLE TO: Quality Assurance Manager
WORK AREA: Remote
SUMMARY: This position will carry out regular audits on client charts, service documentation, and paid claims to assure compliance with Medicaid standards, as well as sharing your findings with the QA team and audited staff. You’ll also be tasked with providing compliance training to our team when needed and teaming up with the Quality Assurance Manager to build strategies to prevent any misuse of resources.
PRIMARY JOB DUTIES
- Audit and report findings on a representative sample of paid claims and service documentation on a monthly basis
- Maintain all audit expectations including but not limited to: timeliness of completion of audits and audit summaries, reporting incidents of potential fraudulent activities, and appropriate communication of needs and findings
- Research, compile and disseminate applicable rules, standards and regulations that are pertinent to the operations of the agency.
- Provide training on compliance efforts to personnel as needed
- Collaborate with the QA manager to develop internal controls to detect and deter fraud, waste, and abuse
- Promote best practice services by providing technical assistance to clinicians and administration
- Participate in all agency required meetings or committees on a regular or as needed basis
- Other projects and duties as required by QA Manager
QUALIFICATIONS
Education
- Bachelor’s Degree and one year experience utilizing data to support the development of quality services, and
Experience
- The preferred education and experience for this position is:
- 5 or more years of experience in public mental health or developmental disabilities
- 2 or more years of quality assurance experience
- Excellent oral and written communication skills, time management, organizational, and computer (MS Office, MS Publisher, Excel, email) skills
Additional Requirements
- Valid Driver’s License, reliable automobile with proof of current liability insurance, acceptable driving record, current vehicle registration and inspection, and a clean criminal record
- Basic mathematical skills
- Ability to read, write, and understand the language of the person served and read and write in English.
- Ability to work as a team member.
Communication Skills: must possess excellent verbal and written communication skills in order to communicate professionally via telephone and in writing. Strong grammar and writing skills are crucial for clear and concise communication with clients, colleagues, and other healthcare professionals.
Interpersonal Skills: The successful candidate must demonstrate the ability to interact and assist in a friendly, compassionate, and professional manner with colleagues, providers, clients, and their families, as they represent both themselves and Path Behavioral Healthcare.
Essential Technical/Motor Skills: Candidates must achieve competency in the Electronic Health Record (EHR) program, telemedicine services, and any additional software programs utilized by the company, ensuring efficient access and updating of client information. The role requires fine dexterity, adept handling, and proficient gripping abilities to perform various tasks.
Background: The candidate must pass all federal and state background checks, and their educational and work history will be confirmed in compliance with company policies.
Accuracy Required in Work and Consequence of Error: Familiarity with Medicaid and OHMAS laws, regulations, and standards to help understand potential risk in order to anticipate them and secure decisions of the agency. Human quality skills are required, which will allow him/her to advise, train and raise awareness amongst agency staff of the significance of business ethics and compliance. This position has a fiduciary and ethical responsibility to the agency, in which errors could result in significant funding infractions for the agency.
Physical Effort (with or without reasonable accommodation): A variety of physical activities are necessary for this position and depending upon the needs of the consumers of the agency. From time to time, travel will be required, which may include out-of-town travel. There will also be interaction with consumers served at each local office.
