JOB TITLE: Quality Assurance Team Leader
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
- Perform a monthly review of HCBS/CORE data to ensure compliance with regulatory guidelines.
- Perform a monthly review of Health Home data to ensure compliance with regulatory guidelines.
- Perform a bi-annual audit of requested HHUNY charts.
- Perform monthly audit of charts requested by GBUAHN.
- Perform monthly quality check requested by HHUNY.
- Monitor the bi-monthly CDPAS consumer Medicaid eligibility list to ensure appropriate follow through and financial loss mitigation activities are occurring.
- Function as a member of the internal audit team.
- Review notary timesheets to ensure compliance with CDPAS program guidelines.
- Monitor and maintain all Regional Health Information Organization (RHIO) rosters.
- Monitor consumers in CDPAS who are turning sixty-five (65) and aging into Medicare to ensure proper Managed Long-Term Care (MLTC) coverage.
- Fulfill and document medical records requested according to the agency’s process.
- Assist with billing and recovery efforts as needed.
- Lead the Quality Assurance Team to ensure the fidelity and timeliness of entry of participating consumers and their personal assistants’ data in the Electronic Visit Verification (EVV) database, Electronic Consumer Record (ECR) and Human Resource Information System (HRIS) databases.
- Coordinate the performance of periodic reviews of database information to ensure continuity across systems.
- Ensure that activity Is performed according to the Taking Control Process Manual and that activity is monitored according to regulatory guidelines.
- Accurately document consumer services and required paperwork in WNYIL’s ECR within two (2) business days of the date of service.
- Participate in maintaining a neat, clean and safe work environment.
- Perform other job-related duties as assigned by the supervisor.
EDUCATION & TRAINING
High school diploma or equivalent
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.
WORK ENVIRONMENT: 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: $39,000 - $44,000
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.
Closing Date: December 9, 2021
Cover Letter and Resume Required to:
Tina Brown, CHRCO
WNY Independent Living, Inc.
3108 Main St.
Buffalo, NY 14214