Volunteers of America
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Quality Assurance Coordinator
at Volunteers of America
COME BE A PART OF A TEAM WHO LOVES TO HELP PEOPLE!
QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Education: Bachelor's Degree in related field or three (3) years of relevant experience in health related field.
- Experience: Minimum of one (1) year of demonstrated experience in QAPI activities and HIPAA compliance activities in a health related work environment.
Skills and Knowledge:
- Ability to facilitate meetings as assigned
- Creative, detailed-oriented and organized
- Excellent written and verbal communication skills with specific ability to maintain accurate records
- Ability to utilize computers and other electronic devices for talks such as data collection and documentation
- Excellent customer service skills
- Must have integrity, practice discretion and practice objective problem solving
- Data collection skills and knowledge of basic statistical principles.
- Skilled in establishing and maintaining effective working relationships with participants, co-workers, medical staff, and contracted providers
- Ability to establish priorities, coordinate work activities and work independently
- Ability to coordinate all credentialing activity between contracted vendors and internal and external credentialing review entities
- Serves as HIPAA Compliance Coordinator for SCCNC. Conducts investigations on possible breaches to privacy, and reports findings to necessary entities.
- Provides initial training to new hires and ongoing existing staff on HIPAA and Fraud, Waste and Abuse Compliance and Quality, as needed.
- Develops and implements all policies and procedure related to HIPAA regulations.
- Participates and offers direction across PACE departments concerning questions and all activities interfacing with HIPAA rules and requirements.
- Retrieves audit reports, monitors and investigates reports of fraud, waste and abuse as required. Initiates timely communication to supervisor, medical staff and Executive staff on results. Creates action plans with input from responsible department staff.
- Analyses risk management data and QI activities data with the objective of identifying and controlling loss to protect the assets of the organization.
- Serves as the credentialing coordinator for contracted providers.
- Ensures contract compliance and credentialing compliance with State and Federal regulations.
- Tracks and updates contractor files monthly (if applicable) with current medical licenses, facility state licenses, registrations, DEA license, and certificates of liability insurance, state surveys.
- Serves as the liaison between the contracted credentials verification organization, and the PACE Organization and the PACE Organizations Credentialing Review Committee (CRC).
- Conducts initial credentialing and re-credentialing of applicable providers.
- Participates in orientation with contract facilities to ensure effective coordination of participant care, as needed provides scheduled onsite inspection of contracted facilities to ensure quality care is provided and compliance with State and CMS regulations
- Monitors applicable websites monthly and as needed for disciplinary summaries from the Board of Medical Examiners, as well as excluded providers from Medicare and Medicaid (OIG)
- In conjunction with the Quality Assurance Manager, monitors and examines data to ensure that data is collected from all appropriate sources to develop and organize the Quality Improvement Plan for Senior CommUnity Care of North Carolina (SCCNC)
- Sends appropriate, timely correspondence to CMS and the state related to Level 1 and II events and all required follow up. Completes the corresponding logs for tracking and trending purposes
- Coordinates the process to evaluate, and resolve medical and non-medical grievances be participants and/or their representatives, ensures information is reviewed for incorporating issues in development of Quality Improvement Initiatives and annual QI plan
- Sends appropriate timely correspondence to participants and/or their representatives related to grievances, appeals, and service delivery requests and completes corresponding logs for tracking and trending purposes
- Responsible for annual HOS Survey for participants. Participates in annual CMS training and contractor communications prior to survey. Creates information sharing file of participant data. Complies with all calendar deadlines related to survey. Works with SCCNC staff to promote participant participation.