Quality Coordinator

QUALITY COORDINATOR

Distinguishing Features of the Class : This is a professional management position responsible for the establishment and oversight in the Department of Health of all quality standards and compliance within the organization as well as agency compliance to County, State, and Federal practices, laws, rules, and regulations. The duties involve ensuring compliance with Private Insurances, Medicaid/Medicare rules and policies by providing staff training; auditing billing submissions and reports, and developing and implementing policies in order to make system improvements. The work involves responsibility and accountability for assessment, policy development, employee health requirements and training, and adherence to standards required by regulations and guidelines set by agency policy, legal mandates, and professional standards of practice. The work is performed under the general direction of the Director of Public Health or his/her designee with leeway allowed for the exercise of independent judgment in carrying out the details of the work. Supervision may be exercised over the work of subordinate professional and clerical staff and interns. The incumbent does related work as required. Typical Work Activities : Oversees all aspects pertaining to Private Insurances, Medicare/Medicaid regulations, audit(s) all billing and medical records for proper coding, claim for payments, billing and payment of services rendered; Responsible for auditing all DOH billing activity for appropriateness with various Federal, State, and Local insurance regulations; including private insurances, Medicaid/Medicare. Ensures current credentialing of all DOH providers for billing purposes and ensures in-network contracts are updated periodically; Active member with oversight of the Corporate Compliance Committee and reports all findings of potential violations, investigations, and results of audits, complaints, violations etc., to the Committee; Ensures documentation of education on the compliance plan annually and for all new employees/agents within Community Services, Department of Health and other related County programs; Audits and completes Quality Improvement planning, execution, and leads corrective action planning with all DOH programs and ensures compliance of all programming within DOH with Federal, State, and Local statutes; Maintains documentation of any investigations, corrective action, occurrence screens and audits in regards to the compliance plan; Ensure reporting of meeting minutes, investigation results and discipline to the Board of Health and Human Services Committee of the Legislature; Oversees and coordinates the department’s mandated trainings programs, required individual or group per the outline of staff job descriptions, grant requirements or professional need; Assists in policy and procedure development, revision, and implementation in carrying out certain aspects of administrative policies, and in monitoring for regulatory changes for such policies; Reviews and updates all existing DOH policies, procedures and written plans for accurateness. Tracks changes per requirements as well as create new written policies, procedures and plans as needed or required by department program objectives; Drafts, reviews, and completes budgets and reconciles budgetary cost center(s) for various DOH programs; Ensures compliance as well as assist Division managers with all grant objectives in order to file grant claim for payments and maintain awareness of grant deadlines; May act as HIPAA consultant to advise staff and assure that policy and procedures are adhered to and will report breaches to Director of Public Health or their designee; Maintains awareness of shared community health documents such as CHIP, CHA, and CSP; Identifies and facilitates opportunities for public health to contribute to collective efforts; Assists divisions in identifying service gaps in aligning current and new programs/activities with community health efforts; Full Performance, Knowledges, Skills, Abilities and Personal Characteristics : Thorough knowledge of County, State, and Federal practices, laws, rules, and terminology regarding quality assurance and agency compliance; Thorough knowledge of modern auditing and accounting methods; Thorough knowledge of monitoring and analyzing financial and billing processes necessary to assist with reimbursement; Thorough knowledge of public health practices and principles, including population-based health improvement; Thorough knowledge of public health accreditation process; Good knowledge of quality improvement science and application; Ability to create policy and procedures; Ability to communicate effectively orally and in writing; Ability to plan and administer staff education development; Ability to use and request technology systems for accurate, efficient, and secure data management, record keeping, and communication for employee health and educational needs; Ability to provide trainings and professional presentations; Ability to describe and apply skills of core competencies within the context of the essential public health services; Ability to establish and maintain cooperative working relationships; Sensitivity to individual client needs with the ability to approach situations and establish policies that take into account diversities and cultural differences; Flexibility; Sound judgment. Minimum Qualifications : Graduation from high school or possession of an equivalency diploma, plus EITHER:

• a) Graduation from a regionally accredited or New York State registered college or university with a Bachelor's degree. OR,
• b) Graduation from a regionally accredited or New York State registered college or university with an Associate’s degree plus two (2) years of full-time experience either supervising or participating in the review, submission and auditing of Private Insurances, Medicaid/Medicare reimbursement forms, insurance or medical claims.

NOTE: Your degree must have been awarded by a college or university accredited by a regional, national, or specialized agency recognized as an accrediting agency by the U.S. Department of Education/U.S. Secretary of Education. If your degree was awarded by an educational institution outside the United States and its territories, you must provide independent verification of equivalency. A list of acceptable companies who provide this service can be found on the Internet at Civil Service Jurisdictional Classification : Exempt This description is a representative summary of the major responsibilities and accountabilities performed by incumbents in this job title. The incumbent may not perform all of the specified duties nor are the listed examples exhaustive. Incumbents may be requested to perform related tasks other than those stated herein. #J-18808-Ljbffr Allegany County