Quality Assurance Specialist

JOB OVERVIEW

JOB TITLE:  Quality Assurance Specialist

DEPARTMENT:  Corporate Compliance

LOCATION:  Buffalo, NY

DIRECT SUPERVISOR:  Compliance Coordinator

GENERAL JOB DESCRIPTION

This position is responsible for assisting with duties within the Corporate Compliance Department with a focus on quality assurance measures, auditing and monitoring.

SPECIFIC DUTIES & RESPONSIBILITIES

  1. Perform a monthly review of HCBS / CORE data to ensure compliance with regulatory guidelines.
     
  2. Perform a monthly review of Health Home data to ensure compliance with regulatory guidelines.
     
  3. Perform monthly, quarterly, bi-annual, and annual audits or quality checks as required by for each Health Home contract including HHUNY and GBUAHN.
     
  4. Assist in the monitoring of CDPAS consumer eligibility, coverage, EVV, and accuracy of data entry.
     
  5. Act as the primary Quality Assurance Specialist for the variety of Medicaid service contracts across the family of agencies.
     
  6. Function as a member of the internal audit team.
     
  7. Monitor and maintain all Regional Health Information Organization (RHIO) rosters.
     
  8. Fulfill and document medical records requested according to the agency’s process.
     
  9. Assist with Agency billing quality assurance activity and with recovery efforts as needed.
     
  10. Participate in the performance of periodic reviews of database information to ensure continuity across systems.
     
  11. Accurately document consumer services and required paperwork in WNYIL’s Electronic Consumer Record (ECR) within two (2) business days of the date of service.
     
  12. Participate in maintaining a neat, clean and safe work environment.
     
  13. Perform other job-related duties as assigned by the supervisor.

EDUCATION & TRAINING

High school diploma or equivalent

OR

Associate degree in Human Services

Professional and life experience may be considered in lieu of, in full or part of academic credentials.

KNOWLEDGE & EXPERIENCE (if required)

  • Experience with the file audit / review or other quality assurance activities is preferred.
     
  • Experience / knowledge of NYS Health Home services is preferred.
     
  • Possess prior knowledge or the ability to learn OMIG / OIG / HHS / CMS / DOH regulations.

High school diploma or equivalent requires three (3) years’ experience in the human services field.

SKILLS & ABILITIES

  • Candidate must have reliable transportation, automobile insurance and the ability to commute to sites in all the counties WNYIL operates.
     
  • Must have intermediate level of knowledge of computers including the use of Excel spreadsheets, databases, word processing and networks.
     
  • Perform in a professional, conscientious, and efficient manner for the purpose of ensuring a better quality of life for persons with disabilities.

WORKING CONDITIONS

WORKING CONDITIONS:  Office / Community

PHYSICAL DEMANDS OF THE JOB:  Sitting for extended periods of time.
Occasional lifting of not more than 15 pounds.

HOURS / SHIFTS:  37.5 – 40 hours per week.
M – F  8:30 a.m – 5:00 p.m.
Overtime rarely required.

CLASSIFICATION:  Full-time, salary, non-exempt, professional staff.
Range:  $36,000  -  $41,000

BENEFITS:  Agency provided group health insurance.
Vision, dental, life, supplemental insurances available.
PTO and paid holiday package.
403(b) retirement with Agency match.
Employee Assistance Program.

OTHER:  Western New York Independent Living, Inc. values our employee safety and follows all recommended NYS required Infectious Disease Prevention Protocols.
Western New York Independent Living, Inc. is an Equal Opportunity Employer.
Reasonable accommodations will be made for people with disabilities.
Western New York Independent Living, Inc. is a scent-free agency.

POSTING INFORMATION

Closing Date:  January 24, 2022

Cover Letter and Resume Required to:

Tina Brown, CHRCO
WNY Independent Living, Inc.
3108 Main St.
Buffalo, NY 14214
Employment@wnyil.org