QI Tech Specialist-HH513601
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Job Location:
Brooklyn, NY - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
JOB SUMMARY
Under the general supervision of the PTW Associate Vice President the Quality Improvement Specialist provides program Quality Assurance and Improvement oversight which includes operational procedures outreach and compliance. The Quality Improvement Specialist implements quality improvement systems data analysis and program processes.
ESSENTIAL JOB FUNCTIONS: List all essential job duties. (To perform this job successfully an individual must be able to perform each essential duty listed satisfactorily with or without a reasonable accommodation. Reasonable accommodations may be made to enable qualified individuals with a disability to perform the essential duties unless this causes undue hardship to the agency.)
- Pull Revenue Cycle Management reports to monitor enrollments entitlements and collections to maximize revenue.
- Reviews a weekly billing report detailing denials inconsistencies with documentation and service billed and clients with no billing for the month.
- Ensure that billing is submitted in a timely manner with the appropriate rate code (Adult Homes HH HH plus AOT Outreach etc.).
- Ensure clean claims are prepared and works with Finance to ensure all billing denials are addressed by identifying Medicaid eligibility issues incorrect CIN DOB etc. and needed corrections are accurately reflected in the corresponding EHR.
- Navigate health information systems such as Foothold Cx360(CORE) MAPP ePaces and PSYCKES to enhance outreach and engagement strategy planning and data informed care.
- Translates data into actionable information for direct care staff and leadership to facilitate data informed care and performance improvement.
- Assist with revenue cycle management including billing submission tracking and reconciliation of unpaid claims.
- Conducts data analysis and reporting to support program operations and to meet reporting requirements of funders/payers. Ensure timely submission of reports to appropriate oversight/funding organizations.
- Defines policy procedures and program standards to ensure internal program compliance with federal state city and agency requirements.
- Communicate effectively with referral sources Managed Care Plans OMH DOHMH DOH and other providers regarding referral enrollment and authorization for services/ level of service determination.
- Review internal and external audits to maintain DOH and Non-Medicaid policies and procedures.
- Cultivates effective relationships with internal ICL programs (Clinics Housing Residential treatment and more) to ensure adequate service delivery.
- Develop workflows to map program processes for referral enrollment billing reporting and quality improvement measures. Design and maintain performance management system to monitor and improve productivity compliance and quality.
- Assist with specialty projects outreach efforts community events member engagement and presentation to increase the census of programs as it relates to revenue improvement.
- Quality wellness checks via telehealth and field visits.
- May be assigned other tasks and duties reasonable related to job responsibilities.
ESSENTIAL KNOWLEDGE SKILLS AND ABILITIES
- Committed to equity diversity inclusion and belonging and active promotion of the ICL values and goals.
- Proficient in Excel formulas and functions (v lookup pivot tables etc).
- Knowledge of agency policies program policies procedures and functions.
- Team player able to work efficiently multi-disciplinary team.
- Ability to provide administrative support to program staff.
- Excellent oral and written communication skills.
- Skilled at data manipulation and visualization.
- Ability to design and maintain electronic filing system.
- Ability to design for the collection of information.
- Ability to prioritize and follow through on multiple tasks simultaneously
- Organized independent and personable.
QUALIFICATIONS AND EXPERIENCE
Bachelors degree and three years of clinical and database experience. Masters degree in human services area preferred. Must have extensive experience using multiple databases and proficient in Microsoft Word and Excel.
Required Experience:
IC
Key Skills
- Sales Experience
- Crane
- Customer Service
- Communication skills
- Heavy Equipment Operation
- Microsoft Word
- Case Management
- OSHA
- Team Management
- Catheterization
- Microsoft Outlook Calendar
- EHS
About Company
ICL is a global specialty minerals and chemicals company operating potash, bromine and phosphate mineral value chains in a unique, integrated business model. The Company employs approximately 11,000 employees worldwide and operates 49 plants in 15 countries worldwide. ICL extracts raw ... View more
