Job Description

Schedule

Full-Time: Monday-Friday 8am-5pm

Under the direction of the Assistant Director of Quality Assurance, the Quality Assurance Specialist will conduct audits on a sampling of clinical records, facilities and programs both on and off site. The Quality Assurance Specialist is responsible for using audit information to assist in improving the overall quality and completeness of clinical documentation, improving safety, and mitigating risk. This individual facilitates audits to ensure that completed documentation meets policy, procedure, and regulatory standards. The Quality Assurance Specialist will be responsible for analyzing the audit results and preparing reports that include data trends and areas of improvement. The Quality Assurance Specialist will engage in ongoing dialogue with program managers to share findings and contribute to conversations regarding quality improvement efforts to include monitoring corrective action plans and reporting the effectiveness of interventions.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Maintain Standards that apply to Confidentiality and 42 CFR/HIPAA.
• At the direction of the Assistant Director of Quality Assurance complete full audits of patient health records and facilities.
• Ensure documentation is in accordance with the directives and guidelines of OASAS, OMH, OTDA, DOH/Health Homes, OMIG, DEA, CARF and/or any other governing, licensing or accreditation agencies.
• Review, retrospectively, medical, and clinical records and pertinent documentation in accordance with established site review tools and company policy.
• Use critical thinking skills to extract, compile, interpret, analyze, and trend data from the electronic health records system and audit tools.
• Effectively communicate data information to stakeholders with various levels of data literacy.
• Conduct random spot checks on the safety and quality of program environments as assigned.
• Utilize Quality Assurance tools and conduct scheduled audits. Revise and coordinate tools necessary for upcoming audits.
• Utilize MS Excel to track documentation workflow and provide status reports.
• Use statistical techniques to provide ongoing reports in the form of tables, charts, and graphs.
• Prepare periodic reports on error rates, incidents, training, and other criteria as specified.
• Identify areas of billing errors and report to supervisor. Assist in communicating this to the Director of Compliance and Compliance Coordinators.
• Identify and interpret trends in data, as they relate continuous quality improvement.
• Uphold the standards of agency’s Continuous Quality Assurance Program.
• Participate in meetings as assigned.
• Record and produce minutes of Quality Assurance Committee meetings as assigned.
• Safeguard and ensure integrity of all data collected within the assigned department.
• Promote individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.
• Performs other duties as assigned or that may develop.

Management has the right to add or change the duties of this position at any time.

Requirements

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

A two-year degree is required, preferred in the field of human services or relevant field; equivalent experience may be considered in lieu of formal education.

Proficient in MS Excel and other Microsoft products, experience with and be able to effectively use an electronic health record (EHR), an essential understanding of process improvement. Must be self-managed, responsive, and dedicated to customer service and support.

CERTIFICATES, LICENSES, REGISTRATIONS

Must maintain valid driver’s license and acceptable driving record.