Quality Assurance Specialist

PCN: 1022
Classification: Full Time; Salaried Non-Exempt; 12-month
Department: Operations
Reports to: Executive Director

QUALIFICATIONS

High School Diploma or GED. Bachelor's Degree in Human Services, Health Administration, Clinical Services, Business Management or a related field. Minimum three (3) years of experience in medical records and compliance preferred. Strong competency with computers. Successful candidate will be a team-oriented professional who demonstrates advanced communication and organizational skills as well as excellent reasoning and interpersonal skills. Experience delivering direct service to SUD client population as a Qualified Health Care Professional (QHP) as defined by OASAS (e.g. LMSW, LCSW, RN, CASAC, and/or PhD in Psychology or Social Work) a plus.

JOB DUTIES

• Monitor all Quality Assurance functions in order to support provision of consistent, quality care to clients;
• Conduct utilization reviews to ensure that clients are receiving appropriate services, continued treatment at the outpatient level of care and intensity of services, and referrals to outside services;
• Monitor client progress in accordance with treatment plans and offer recommendations regarding care and referrals;
• Interface with insurance companies to obtain required pre-authorizations or to ensure continuity of care;
• Coordinate, prepare, and review regulatory and compliance documentation in accordance with OASAS regulations;
• Train and coach direct care staff in Quality Assurance procedures;
• Communicate with regulatory agencies regarding pre-submission strategies, potential regulatory pathways, compliance test requirements, or clarification and follow-up of submissions under review;
• Prepare or direct the preparation of additional information or responses as requested by regulatory agencies;
• Maintain agency's program audit systems - compile and distribute audit reports including, but not limited to, client record Quality Assurance and client perception of care;
• Prepare or maintain files as necessary to obtain and sustain service approval;
• Use relevant information and individual judgment to determine whether events or processes comply with applicable laws, regulations, or standards;
• Independently observe client treatment and/or program services in order to develop clear, useful recommendations to management for improvement of treatment and/or program services;
• Act as HIPAA Privacy Official - ongoing management of information security, policies, procedures, and technical systems in order to maintain confidentiality, integrity, and availability of all organizational healthcare information systems and records;
• Act as Corporate Compliance Officer, reporting directly to the Board of Directors and Executive Director for overall management of the Council's Corporate Compliance Plan - includes conducting exclusion checks in accordance with OASAS Administrative Fiscal Guidelines;
• Evaluate relevant laws and regulations to determine impact on organizational activities - communicate changes to management and staff;
• Other duties as assigned.

Compensation: $45k-50k annually, commensurate with experience.

Excellent benefits include PTO, Medical, Dental, Vision, FSA, HSA, Employee Assistance Program, Pet Insurance, Identity Protection, Life Insurance, Long-Term Disability, Short-Term Disability, 403(b) Retirement, 403(B) Employer Matching, and exciting opportunities for professional development.

Alcohol & Drug Council of Tompkins County is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of age, race, creed, color, national origin, ancestry, political affiliation, marital status, sexual orientation, gender, gender identity or expression, genetic information, amnesty status, veteran status, or disability.

Alcohol & Drug Council of Tompkins County, Inc. is a Certified Living Wage Employer, STAR LRP-approved, and Nurse Corps LRP-approved.