What are the responsibilities and job description for the Quality Assurance Evaluator/Auditor position at Fond du Lac Reservation?
- Responsibilities: · Maintain compliance with standards of internal auditing or health care operations related to evaluation and self-monitoring.
· Work and assist with data metrics, documentation standards and system tools to effective evaluation and quality review procedures.
· Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, and attending training of auditing/evaluation.
· Prepare departmental and data quality reports by collecting, analyzing, and summarizing information, data trends and professional bench markers.
· Serves as the primary quality control resource for problem identification, resolution, quality issue reporting and continuous improvement within Fond du Lac Human Services Division (FDL HSD).
· Provide reports to management on quality assurance, issues, trends and system deficiencies.
· Monitors and administers compliance reviews and audits within applicable federal, state, tribal and local regulations.
· Conduct medical records documentation and coding/billing audits, assessing the accuracy of standard billing process and coding; and determine compliance with appropriate policies, procedures, and Federal and state regulations.
· Assist in assigned project to review of audit alleged violations of rules, regulations, policies, procedures and standards of conduct through approved investigative procedures.
· Assisted as an independent review and evaluation body to ensure that compliance issues and concerns within the organization are being appropriately evaluated, investigated, and resolved.
· Conduct audits as requested. Plan and organize work assignments to complete projects in an efficient manner. Prepare comprehensive reports, making recommendations to correct deficiencies and practice or process improvements.
· Appropriate/Professional work attire is required.
· Must attend all mandatory department trainings.
· Ensures confidentiality of financial records and all records for employees and/or clients.
· Displays a responsive and professional manner in promptly responding to all requests, complaints, and problems.
· Recognizes that each employee is a representative of the Fond du Lac Band of Lake Superior Chippewa and is responsible for demonstrating courtesy, respect, and sensitivity to the needs of all others, including visitors and co-workers.
· Represents the Fond du Lac Band of Lake Superior Chippewa and the department in a positive and professional manner in the community.
· Required to maintain proper attendance including reporting to work on time in accordance with applicable policies.
· Maintains a clean and organized work area.
· Due to changes and modifications in the job from time to time, employees are required to be flexible and assume other responsibilities assigned by management as deemed necessary.
- Qualifications: · No Driver's License is required.
Associates Degree in healthcare, human resources, science or similar health related field required; Bachelor Degree preferred.
· A minimum of 4 years of experience in a health care organization or regulated industry.
· 2-4 years of experience in clinical auditing, evaluation process and regulatory compliance.
· 1-2 years of experience working with Native American communities, culture, customs, and beliefs is required.
· 1-2 years of experience working with Native Americans clients, communities and is able to demonstrate cultural sensitivity is required.
· Familiarity with health care and human services laws, regulations and standards.
· Well organized and accustomed to maintaining excellent records and documentation.
· Knowledge of computer applications to include word processing, databases and/or data entry, spreadsheet, and Microsoft Outlook is required.
· Ability to communicate effectively orally and in writing is required.
· Ability to work independently and establish priorities is required.
· Attention to detail and accuracy is required.
· Ability to establish professional and harmonious working relationships on all projects and with all parties involved.
· Subject to drug and alcohol testing in accordance with the Fond du Lac Reservation’s Personnel Policies.
· Subject to pre-employment and annual background checks.
· Subject to immunization review and submitted proof of required vaccinations.
· Some travel may be required.
PHYSICAL REQUIREMENTS:
· Normal physical requirements.
T he Fond du Lac Band of Lake Superior Chippewa, Nagaajiwanaang ( Where the water stops ), is one of the six Bands of the Minnesota Chippewa Tribe and a proud sovereign Ojibwe nation. We strive to be a diverse , supportive , and inclusive workforce that employs Fond du Lac Band members, native peoples , and those from our surrounding communities .
As one of Carlton County's largest employers, the Fond du Lac Band is dedicated to elevating the community through a broad spectrum of programs and enterprises including our gaming facilities, tribal government, health services, and education that promot es our language, culture, and the preservation of our natural resources .
The Fond du Lac Band is a n employer that cultivate s the growth of our employees and our programs ; a place where you can develop your skills and gain experience that will positively impact the lives of those who call the Fond du Lac Band home. Our hiring practices follow tribal employment rights outlined in Fond du Lac O rdinance #12/94 (TERO).
Join the Fond du Lac Band of Lake Superior Chippewa in our mission to preserve and promote our community while contributing to its vibrant future.
Salary : $24 - $28
