TITLE: Quality Assurance Specialist (Remote)

RESPONSIBLE TO: Quality Assurance Manager

WORK AREA: Remote

SUMMARY

This position provides quality assurance functions for programmatic operations. Quality assurance is a

process of verifying that services rendered meet internal and external healthcare compliance standards.

PRIMARY JOB DUTIES

• Audit and report findings on a representative sample of paid claims and service documentation on

a monthly basis

• Maintain all audit expectations including but not limited to: timeliness of completion of audits

and audit summaries, reporting incidents of potential fraudulent activities, and appropriate

communication of needs and findings

• Research, compile and disseminate applicable rules, standards and regulations that are pertinent

to the operations of the agency

• Provide training on compliance efforts to personnel as needed

SKILLS, KNOWLEDGE, & ABILITIES:

• Collaborate with the QA manager to develop internal controls to detect and deter fraud, waste,

and abuse

• Promote best practice services by providing technical assistance to clinicians and administration

• Participate in all agency required meetings or committees on a regular or as needed basis

• Other projects and duties as required by QA Manager

PERFORMANCE EXPECTATION:

• Serve as a role model for professional and support staff by consistently conducting him/herself in

a professional and ethical manner in all situations, including but not limited to, promptness of

completing assignments, verbal/non-verbal communications, maintaining professional

boundaries, representing the Agency with a professional image, and complying with Federal AntiKickback and Fraud Laws.

• Maintain therapeutic boundaries with consumers, families, and guardians

• Have an understanding of Client Rights

• Have an understanding of abuse, neglect, and exploitation rules

• Have a basic understanding of mental health and related symptomology

• Have or develop and understanding of FLSA, HIPAA, HITECH, Labor Law, OIG guidance and

law related to Medicaid service delivery

• Have or develop a working knowledge of effective auditing practices

• Consistently practice appropriate service records documentation, pursuant to State, Federal, and

Agency Policies and Procedures

• Establish and maintain effective working relationships with colleagues and persons served

• Express ideas clearly, both verbally and written

• Ability to plan and execute work effectively

• Be aware of expiration dates and maintain current training and recertification requirements

• Attend and participate in all team meetings, committees, and audit as requested

QUALIFICATIONS:

Education/Experience

• The minimum requirement for this position is:

o Bachelor’s Degree and one year experience utilizing data to support the development of

quality services, and

o Excellent oral and written communication skills, time management, organizational, and

computer (MS Office, MS Publisher, Excel, email) skills

• The preferred education and experience for this position is:

o 5 or more years of experience in public mental health or developmental disabilities

o 2 or more years of quality assurance experience

Additional Requirements

• Valid Driver’s License, reliable automobile with proof of current liability insurance, acceptable

driving record, current vehicle registration and inspection, and a clean criminal record

• Basic mathematical skills

• Ability to read, write, and understand the language of the person served and read and write in

English

• Ability to work as a team member

• Reliable transportation

Accuracy Required in Work and Consequence of Error: Familiarity with Medicaid and OHMAS

laws, regulations and standards to help understand potential risk in order to anticipate them and secure

decisions of the agency. Human quality skills are required, which will allow him/her to advise, train and

raise awareness amongst agency staff of the significance of business ethics and compliance. This position

has a fiduciary and ethical responsibility to the agency, in which errors could result in significant funding

infractions for the agency.

Physical Effort (with or without reasonable accommodation): A variety of physical activities are

necessary for this position and depending upon the needs of the consumers of the agency. From time to

time, travel will be required, which may include out-of-town travel. There will also be interaction with

consumers served at each local office.