Quality Assurance Specialist

Quality Assurance Specialist

At McIntosh Trail Community Service Board, we offer individuals experiencing symptoms associated with mental illness, addictive disease and/or developmental disability the hope for optimal functioning and recovery by providing quality behavioral health services and supports.

Summary

Under general to limited supervision, the Quality Assurance Specialist will perform professional and administrative work coordinating and implementing a quality assurance program in a facility providing specialized or community-based services or assisting with the implementation of an intense quality assurance program of substantial scope and complexity for persons with mental illness and/or developmental disabilities.

Responsibilities

• Ensures accurate and timely processing of authorizations.
• Posts incoming Carelon Files with Registrations, authorizations and discharges.
• Researches and resolves rejections.
• Communicates correction instructions with staff, re-submits files when updated.
• Submits OTRs in GAMMIS and monitors for same day service needs.
• Checks portals for authorization updates.

Minimum Qualifications

• High School Diploma
• 1-2 years of experience in healthcare quality assurance or administration.
• Strong attention to details and communication skills
• Proficiency in Microsoft Excel, GAMMIS, payer portals and electronic health records.

Preferred Qualifications

• Associate or bachelor's degree