The QA/I Specialist (Billing and Internal Controls) participates in the mission of the Quality Assurance and Improvement Department which is to promote quality, integrity and compliance through ongoing monitoring, evaluation, consultation, education, investigation and the development of quality and compliance-related processes and products. This position audits designated clinical and/or administrative records for conformance to federal and state regulations, including Medicaid and Medicare billing, and agency policy. While the primary and most frequent activity is auditing, audit findings would likely result in follow-up consultation and training. This position also provides ongoing training in regulations, standards, and agency policies and practices that bear on such processes as documentation to support billing and internal control procedures. These responsibilities apply to all ICL and affiliate programs.
ESSENTIAL JOB FUNCTIONS:
To perform this job successfully, an individual must be able to perform each essential duty listed satisfactorily. Reasonable accommodations maybe made to enable qualified individuals with disabilities to perform the essential functions unless this causes undue hardship to the agency.
Maintain current knowledge of applicable federal and state laws, regulations and accreditation standards that pertain to the operations of programs that receive Federal, State, City or other third party funding for business and service delivery operations.
Cooperate with the state Attorney General's Office or other legal entities, and organization officers in any compliance reviews or investigations.
MINIMUM QUALIFICATIONS AND EXPERIENCE REQUIREMENTS:
REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
RELATIONSHIPS WITH OTHERS:
This position reports to the Director of QA/I for Billing and Internal Controls. The most important activity is internal auditing. Other important activities include, but are not limited to, consultation, education, and investigation. These activities require contact and communication with executive managers, program managers and their staffs and may include persons served.
This position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands, and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the agency at the sole discretion of the management.