What are the responsibilities and job description for the Quality Specialist position at PROMESA R.H.C.F.?
Acacia Network, the leading Latino integrated care nonprofit in the nation, offers the community, from children to seniors, a pathway to behavioral and primary healthcare, housing, and empowerment. We are visionary leaders
transforming the triple aim of high quality, great experience at a lower cost. Acacia champions a collaborative environment to deliver vital health, housing and community building services, work we have been doing since 1969. By
hiring talented individuals like you, we’ve been able to expand quickly, with offices in Albany, Buffalo, Syracuse, Orlando, Tennessee, Maryland and Puerto Rico.
POSITION OVERVIEW:
Under the supervision of the Senior Administrator Health Homes, the Quality Specialist is responsible for performing comprehensive analyses of clinical documentation, review of key administrative and compliance requirements,
as well as informs the leadership team of audit findings, potential deficiencies and assists in the development of corrective action plans to evaluate procedures and services performed as required by DOH & Bahn policies and any
other regulatory agency for Health Home Agency. In addition, this role is responsible for ensuring quality of documentation, performance trends with a high degree of accuracy and quality, maintaining current knowledge of
healthcare regulatory guidelines that impact reimbursement and quality outcomes and communicates with up-line management of identified trends and areas of risk to provide recommendations for improvement in the patient
experience and clinical outcomes.
Under the direction of the Senior Administrator Health Homes facilitates quality assurance and improvement projects. Skills and competencies required for the position include planning, organization, analytical problem solving, and
leadership skills.
This position pays: $18.00-$19.99 per hour.
KEY ESSENTIAL FUNCTIONS:
• Concurrent reviews of DOH medical records to validate completeness, compliance, and consistency with clinical documentation in accordance with federal and state regulations.
• Champion Evidence Based Practices by leading Health home electronic record review, core services, progress notes compliance and performance improvement projects.
• Monitor and analyze behavioral health documentation (monthly program specific chart audits). Document quality assurance audit reports/summaries.
• Modify business processes to measure patient outcomes and satisfaction as drive by patient satisfaction survey (Perception of Care survey).
• Develop and monitor systems to ensure compliance with (Health Insurance Portability and Accountability Act). Research state regulations and compliance guidelines.
• Establish compliance tracking systems with timeliness as mandated by applicable legislative and accrediting organizations, including trend identification and root cause analysis.
• Works with the BAHN Portal to enter engagement and outreach activities for clients.
• Work with the BAHN Team to create outreach and enrollment segments.
• Must be able to accurately input high volume of information accurately.
• Alerts Supervisor of any inaccuracies/ inconsistencies at time of discovery.
• Track reporting information via excel spreadsheets and submit to Management team weekly and/ or as needed.
• Ensures accuracy of daily census reporting.
• Assists in clerical duties as needed.
• Engages in internal audits.
• Processes enrollments and disenrollment’s of clients into and out of the program.
• Utilizes the MAPP Portal to create enrollment and outreach segments.
• Communicate with BAHN Staff to create and follow up on member attribution status and enrollment/ disenrollment process.
• Monitor, track, and distribute Top-Down attributions to Outreach Team Lead.
• Transcribe engagement attempts reported from Care Managers, Health Navigators, and Outreach Team.
• Monitor and track the Bottom-Up Referral list after being submitted to BAHN for approval.
REQUIREMENTS:
• Associates degree in Social Work, Psychology, Public Health, Registered Health Information Administration, or related field required.
• Ability to work with a strong team of professionals in a culturally diverse environment.
• Ability to multitask and to work and function under pressure.
• Proficient knowledge of medical terminology, ICD-10 and CPT codes.
• Knowledge of Medicaid and other federal/state compliance guidelines.
*Acacia Network is an equal opportunity employer*
Salary : $18 - $20
