Clinical Quality Assurance Analyst

Job Title: Clinical Quality Assurance Analyst

Location: Albany - Remote with travel

- Travel may be required up to 25% of the time.

• Some overnight stays will be required, sometimes for the entire work week.
• An expense budget will be available for travel costs.
  • Expense invoices will be due within 7 days of travel.

- Remote work will be allowed when not traveling.

Key Responsibilities:

• Evaluate child/youth’s records for compliance to applicable regulations.
  • Clearly communicate evaluation requirements and follow up.
  • Evaluate documentation against applicable State/Federal regulations.
  • Collect data and documentation to support compliance findings.
  • Utilize technology to convert hard copy documentation to electronic and submit via secure file transfer.
  • Record, summarize, and communicate compliance findings for the Children’s Transformation Program.
  • Assist in determining trends in non-compliance.
  • Make appropriate and timely recommendations to project management.
• Assist with the ongoing operationalization of project’s processes and procedures.
• Assist with all internal and external reporting.
• Build and maintain relationships with stakeholders to provide a high level of customer service.
• Traveling to provider sites to perform case reviews.

Required Qualifications:

• Bachelor’s degree in public health, healthcare management, psychology, human services, or related field.
• A minimum of 2 years of A minimum of 2 years of experience as a Healthcare Compliance Analyst, Auditor, Care Manager, or Medicaid Provider, in a role responsible for conducting oversight, compliance audits or chart reviews, or ensuring quality of care.
• An equivalent combination of advanced education, training, and experience will be considered.
• Experience with Medicaid fee-for-service and/or Managed Care billing.
• Proficiency in MS Excel, MS Word, MS Outlook, MS Visio, MS PowerPoint and MS SharePoint.
• Strong analytical and problem-solving abilities; able to evaluate data and make sound, evidence-based decisions.

Preferred/Desired Qualifications:

• Extensive knowledge of, and experience with, Home and Community-Based Services (HCBS) Waiver programs, including the 1915(c) NYS Children’s Waiver, either as a provider or compliance officer.
• Experience working with eMedNY, CANS-NY, UAS-NY, Medicaid Health Homes, Medicaid Managed Care Organizations (MMCOs), or other related programs/systems.
• Experience with NYS Medicaid billing, including the use of various Electronic Health Records (EHR) systems.
• Experience working with Office of Mental Health (OMH), Office for People with Developmental Disabilities (OPWDD), or Office of Children and Families (OCFS).
• Ability to manage time independently while meeting deadlines and adhering to high performance standards.
• Experience with compliance audits or chart reviews.
• Ability to work with and relate to staff and demonstrate active listening skills.
• Process oriented and results-driven work strategy.
• Ability to foster teamwork with all levels of management and staff.
• Ability to work well independently and within a team.
• Exceptional customer service relationship techniques, including superior verbal and written communication skills.
• Excellent accuracy and attention to detail.