As a Quality Assurance Analyst, you will collaborate with team members to support our clients through today’s ever-changing healthcare landscape. Your day-to-day role as a consultant will be to provide analysis expertise to evaluate the performance of the 1915(c) Children’s Waiver across New York State. This role will be based in our Albany office, but is currently remote.
Duties
- Evaluate child/youth’s case for compliance to applicable regulations.
- Clearly communicate evaluation requirements and follow up.
- Evaluate documentation against applicable State/Federal regulations.
- Collect data and documentation to support compliance findings.
- Utilize technology to convert hard copy documentation to electronic and submit via secure file transfer.
- Record, summarize, and communicate compliance findings for the Children’s Transformation Program.
- Assist in determining trends in non-compliance.
- Make appropriate and timely recommendations to project management.
- Assist with the ongoing operationalization of project’s processes and procedures.
- Assist with all internal and external reporting.
- Build and maintain relationships with stakeholders to provide a high level of customer service.
Mandatory Requirements
Requirements
- Bachelor’s Degree in Nursing, mental health counseling, social work, care management, healthcare compliance, public health, healthcare program management, psychology, human services or related field.
- A minimum of 2 years of experience as a Healthcare Compliance Analyst, Auditor, Care Manager, Children’s Behavioral Health Provider, Registered Nurse, LMSW, LMHC, or closely-related field, in a role responsible for conducting oversight, compliance audits or chart reviews, to ensure quality of care.
- Experience with monitoring healthcare program compliance or Medicaid fee-for-service and/or Managed Care billing.
- Proficiency in MS Excel, MS Word, MS Outlook, MS Visio, MS PowerPoint, and MS SharePoint.
- LMSW, LCSW, RN, CIA, or related certification.
- Extensive knowledge of, and experience with, Home and Community-Based Services Waiver programs, including the 1915(c) NYS Children’s Waiver, either as a provider or compliance officer.
- Experience working with eMedNY, CANS-NY, UAS-NY, Medicaid Health Homes, Medicaid Managed Care Organizations (MMCOs), or other related programs/systems.
- Experience with NYS Medicaid billing, including the use of various Electronic Health Records (EHR) systems.
- Experience working with OMH, OPWDD, or OCFS.
- Experience with compliance audits or chart reviews.
- Ability to work with and relate to staff and demonstrate active listening skills.
- Process oriented and results-driven work strategy.
- Ability to foster teamwork with all levels of management and staff.
- Ability to work well independently and within a team.
- Superior verbal and written communication skills.
- Excellent accuracy and attention to detail.
- Experience in meeting deadlines and adhering to strict standards of performance.