ICL

  • Quality Insurance Technical Specialist

    Job Locations US-NY-Brooklyn
    Position Number
    HH513601
    Department
    Pathway to Wellness
    Type
    Regular Full-Time
    FLSA Status
    Exempt
    Maximum Salary
    USD $50,000.00/Yr.
  • Overview

    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.

    Responsibilities

    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.

     

    • Conduct audits of designated corporate business operations for compliance with agency and departmental policies and procedures. Develop written reports of findings and recommendations for executive and program managers and Board of Directors' Committees as directed.
    • Conduct audits of electronic and paper clinical case records for documentation to support Medicaid billing invoices. Develop written reports of findings and recommendations for executive and program managers and Board of Directors' Committees as directed.
    • Conduct audits of compliance with Federal, State and local contracts and develop written reports of findings and recommendations for executive and program managers and Board of Directors' Committees as directed.
    • Conduct audits of trading partner and business associate agreements and develop written reports of findings and recommendations for executive and program managers and Board of Directors' Committees as directed.
    • Conduct audits of designated system-related information security plans throughout the agency's network to ensure alignment between security and privacy practices, and acts as a liaison to the information systems department.
    • Provide consultative, technical, and training support to program staff regarding billing documentation standards and strategies for enabling conformance to such standards. This includes presentations to new employees and periodic presentations to existing employees on billing-related standards and other designated topics.
    • Successfully complete training as an investigator and conduct internal investigations as assigned.
    • Abstract data from records to evaluate (a) conformance to billing documentation standards and (b) utilization of services in programs that bill Medicaid or Medicare for reimbursement of such services, and develop written reports of findings and recommendations for executive and program managers and Board of Directors' Committees as directed.
    • Follow-up on assigned complaints regarding violations of any laws or regulations. Conduct investigations into allegations of non-compliance with the corporate compliance plan and develop written reports of findings and recommendations for executive and program managers and Board of Directors' Committees as directed.
    • Work with management, key departments, and committees to ensure the agency complies with provisions of the corporate compliance plan.
    • Provide, as directed, initial and ongoing corporate compliance-related training and orientation to all employees, volunteers, medical and professional staff, contractors, alliances, business associates, and other appropriate third parties.
    • Initiate, facilitate and promote activities to foster awareness within the organization and related entities of the agency's corporate compliance plan.
    • Serve as consultant or trainer to the organization for all departments and appropriate entities in the areas of billing and internal controls as directed.
    • 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.

    • Perform other tasks as assigned.

     

     

    Qualifications

    MINIMUM QUALIFICATIONS AND EXPERIENCE REQUIREMENTS:

     

    • Master's degree in a managerial or administrative discipline plus one year of experience performing either finance-related, managerial, quality assurance or other audit work or
    • Bachelor's degree in accounting or human services or related field and at least three years of experience in a human  services setting performing either finance-related, managerial, quality assurance or other audit work

     

    REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

     

    • Knowledge of general accounting practices;
    • Knowledge of Federal and New York State laws and regulations pertaining to the operation of outpatient clinics, diagnostic and treatment centers, day treatment programs, assertive community treatment and case management teams, community residences, intermediate care facilities and individualized residential alternative programs;
    • A strong knowledge base and experience in appropriate coding and billing practices;
    • Knowledge of multiple reimbursement systems
    • Knowledge of multiple regulations, standards, policies, and requirements pertaining to clinical documentation, coding, and billing;
    • Knowledge of multiple third-party payer requirements;
    • Knowledge of Microsoft Office software;
    • Knowledge of psychiatric rehabilitation interventions and accepted practices for documenting related services;
    • Auditing skills;
    • Effective organizational skills (e.g. planning, scheduling, prioritizing tasks);
    • Effective presentation skills (e.g. prepare and deliver a written or spoken presentation with supporting materials);
    • Effective problem-solving skills;
    • Effective interpersonal skills;
    • Strong analytical skills;
    • The ability to interpret legal requirements;
    • The ability to accurately interpret and implement regulatory standard;
    • An ability to gather, analyze and evaluate facts and to prepare and present concise oral and written reports;
    • Ability to express self clearly both verbally and in writing;
    • Ability to work as a member of a team;
    • Ability to work unsupervised;
    • Ability to establish rapport with physicians and other healthcare practitioners; and
    • Ability and willingness to work with culturally diverse employees.

    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.

                                                                          

     

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