Job Description
Job Title: Clinical Quality Assurance Analyst
Location: Albany - Remote with travel
- Travel may be required up to 25% of the time.
- Some overnight stays will be required, sometimes for the entire work week.
- An expense budget will be available for travel costs.
- Expense invoices will be due within 7 days of travel.
- Remote work will be allowed when not traveling.
Key Responsibilities:
- Evaluate child/youth’s records 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.
- Traveling to provider sites to perform case reviews.
Required Qualifications:
- Bachelor’s degree in public health, healthcare management, psychology, human services, or related field.
- A minimum of 2 years of A minimum of 2 years of experience as a Healthcare Compliance Analyst, Auditor, Care Manager, or Medicaid Provider, in a role responsible for conducting oversight, compliance audits or chart reviews, or ensuring quality of care.
- An equivalent combination of advanced education, training, and experience will be considered.
- Experience with Medicaid fee-for-service and/or Managed Care billing.
- Proficiency in MS Excel, MS Word, MS Outlook, MS Visio, MS PowerPoint and MS SharePoint.
- Strong analytical and problem-solving abilities; able to evaluate data and make sound, evidence-based decisions.
Preferred/Desired Qualifications:
- Extensive knowledge of, and experience with, Home and Community-Based Services (HCBS) 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 Office of Mental Health (OMH), Office for People with Developmental Disabilities (OPWDD), or Office of Children and Families (OCFS).
- Ability to manage time independently while meeting deadlines and adhering to high performance standards.
- 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.
- Exceptional customer service relationship techniques, including superior verbal and written communication skills.
- Excellent accuracy and attention to detail.
Job Tags
Work at office, Remote work, Night shift