QA Specialist Health Homes

Area-Agency-On-Aging-; Longview (WA); On-site; USD 52,000 - 78,000; Full time

Benefits offered by this job

PERS retirement

Medical, dental and vision insurance

Paid time off

Job summary

AAADSW is seeking a Quality Assurance and Contract Monitoring Specialist to conduct QA reviews for the Health Home program and advise leadership on planning and improvement. You will serve as the ProviderOne subject matter expert, ensuring billing is properly supported in related systems, and work closely with the fiscal team and Managed Care partners.

You will review subcontracted Care Coordination Organizations for contract compliance, help develop training materials, and generate reports for

Qualifications

• Bachelor's degree in social work, health or social science, public administration or related field.
• Two years of experience monitoring records or compliance activities.
• Valid driver's license, vehicle insurance and reliable transportation.

Responsibilities

• Conduct quality assurance monitoring for the Health Home program across AAADSW's service area.
• Communicate and collaborate with LTSS Director and LTSS Program Manager on compliance trends.
• Participate in Health Home Lead and CCO network meetings.

Skills

Compliance monitoring

Data analysis

Communication

Teamwork

Time management

Education

Bachelor's degree in social work, health or social science, public administration or related field

Tools

HAP Database

Job description

Description

• FLSA: Non-Exempt
• Reports to: Long Term Services and Supports Manager Longview
• Supervisory Responsibilities: None
• Pay Grade: 19

SUMMARY:

Conducts AAADSW's quality assurance and contract monitoring reviews for the Health Home program while consulting with program leadership on ongoing planning and improvement activities; represents HCA for grievances; and serves as the ProviderOne subject matter expert, ensuring program billing is supported in related systems, working closely with the fiscal team and Managed Care partners.

ESSENTIAL FUNCTIONS:

• Conduct quality assurance monitoring for the Health Home program across AAADSW's regional service area(s), including but not limited to DSNP and CCO audits for all contracted providers.
• Communicate and collaborate with the LTSS Director and LTSS Program Manager on compliance monitoring trends by way of report generation and analysis.
• Participate as requested in Health Home Lead and CCO network meetings.
• Review subcontracted Care Coordination Organizations for contract compliance, in coordination with the Contracts Team.
• Collaborate with the LTSS Program Manager on training materials and presentations to the Care Coordination Organization network.
• Communicate and problem-solve effectively with colleagues at all levels of the organization.
• Co-facilitate HCA's Health Home in-person training for the network.
• Train the CCO network on the HAP Database and provide technical assistance.
• Collaborate on requests for public records of Health Home participants.
• Serve as the primary liaison for the management of, research on, and communication with fiscal regarding payment discrepancies with Lead entity billing activities.
• Confirm CCO billing has the necessary supporting documentation.
• Act as the Health Action Plan subject matter expert and provide guidance to staff as needed in data entry in the HAP database.
• Review, create, and process reports and documents necessary for HH Lead compliance.
• Review, approve, and log CCO network Tier exceptions.

WORKING CONDITIONS AND PHYSICAL EFFORT:

• While performing the duties of this position, the employee is regularly required to talk, hear, stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls, and reach with hands or arms.
• The employee occasionally lifts or moves up to 20 pounds.
• Specific vision abilities required by this job include close vision and the ability to adjust focus.
• Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
• Work is normally performed in a typical interior/office work environment.
• When attending meetings or community events, the employee travels by automobile and is exposed to changing weather conditions.

Requirements

MINIMUM QUALIFICATIONS:

• Bachelor's degree in social work, health or social science, public administration or a related field.
• Two years of experience monitoring records and/or involvement with compliance activities. Equivalent education/experience will substitute for all minimum qualifications except when there are legal requirements, such as a license, certification or registration.
• Possession of a valid driver's license and minimum state-required vehicle insurance and have use of reliable transportation.

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge and experience in reviewing client records and contractor records for compliance.
• Ability to collect, analyze and evaluate data and information for program management evaluation.
• Ability to manage and complete multiple work projects with quality results in a timely manner meeting identified deadlines.
• Ability to use technology including hardware and software applications, the Internet and to learn new applications.
• Ability to work independently.
• Ability to work effectively as a team member with a wide range of diverse staff and community and to establish and maintain effective working relationships.
• Computer and software skills; ability to operate general office equipment; work at a desk using a phone and computer for up to eight hours a day.
• Ability to communicate verbally in the English language in face-to-face one-on-one settings, in Team settings, by personal computer, or using a telephone.
• Ability to communicate in writing in the English language to generate records for review by administrative law judges and other staff by way of reports, letters, email and notes.
• Ability to travel and access client homes and participate in off-site meetings which may not be ADA accessible.

Benefits include WA state PERS retirement, medical, dental and vision insurance, personal holidays, and generous sick and vacation leave.

• AAADSW is an Equal Opportunity Employer
• A criminal background check will be administered

The statements contained herein reflect general details as necessary to describe the essential functions of this job, the level of knowledge and skill typically required and the scope of responsibility but should not be considered an all-inclusive listing of work requirements. Individuals may perform other duties as assigned including work in other functional areas to cover absences or relief, to equalize peak work periods or otherwise balance the workload.

Additionally, AAADSW supports an inclusive environment for individuals with or without disabilities. Individuals who feel they may need reasonable accommodation to perform the essential functions of this position are encouraged to contact the Human Resources department for further assistance.