The Quality Assurance and Corporate Compliance Specialist assists with the implementation and oversight of quality and compliance activities, health information management, and analytic reporting for Prime Care Coordination. In conjunction with the Director of Quality & Compliance and leadership team, the Quality Assurance Specialist will contribute to the execution of the strategic direction and brand of care coordination for the CCO/HH that aligns with the long term vision and goals of the I/DD service delivery system transformation to managed care.
Essential Job Functions:
- Remain abreast of current and proposed regulations pertaining to Quality and Corporate Compliance and act as a resource for information; coordinate guidance and training to all PCC programs.
- Assist in development, implementation, monitoring and training of Quality/Compliance policies and procedures for PCC and ensure employees are educated, trained and adhere to established policies and procedures.
- Assist with training and monitoring of policies and procedures for HIPAA Privacy in accordance with the federal HIPAA Rule and Omnibus Act. Respond to alleged HIPAA privacy violations. Assist in the implementation and oversight of a uniform system for handling of such violations. Ensure proper reporting of HIPAA privacy violations as required.
- Respond to alleged violations of rules, regulations, policies, procedures, and the Code of Ethical Conduct by evaluating or recommending the initiation of investigative procedures; assist in the implementation and oversight of a uniform system for handling of such violations.
- Maintain and distribute reports on the success of quality programs driven by statistics; to include audit findings and analysis of trends, patterns, systemic issues and potential quality improvement opportunities.
- Facilitate, coordinate, and serve as main reporting contact for all HUB Quality Staff for incident management, health information management, and monitoring of metric requirements.
- Serve as PCC primary IRMA user and investigator; implement the incident management process including filing of incidents in IRMA or similar database and following up on safeguards put in place for individuals served as applicable.
- Assist with oversight of internal audit functions/tools for all PCC programs as necessary to ensure compliance and quality care.
- Complete investigations as well as special and internal control audits as assigned by the Director of Quality & Compliance.
- Serves as a member of the Quality Management team and engage in general quality and improvement activities including satisfaction survey process related to families and individuals served.
- Participate on quality committees and sub-committees
- Perform other duties as assigned by supervisor
Knowledge, Skills, and Abilities:
- Knowledge of OPWDD and/or DOH regulations, programs, and service delivery system including knowledge of audit, incident and quality assurance regulations, Medicaid Service Coordination, managed care or services for people with intellectual and developmental disabilities and/or health home care management.
- Must be able to multi-task, establish priorities, and meet deadlines.
- Ability to work in a collaborative environment, work independently, and motivate others.
- Ability to communicate effectively, both orally and in writing.
- Ability to act quickly, assess, and act appropriately in crisis situations
- Proficient with technology and understanding of health records
- Maintain appropriate confidentiality and discretion at all times.
Education and Experience:
- Bachelor’s Degree in Healthcare, Business, Human Services Administration, or related field.
- Minimum 3 years of experience in the Quality Assurance and Corporate Compliance areas within a health care or human services setting.
- Knowledge of HIM (Health Information Management)
- Possession of valid, unrestricted NYS driver’s license required