QA Auditor (HEALTH PROFESSIONAL II) - Pueblo Regional Center

State of Colorado•Pueblo, CO

7d•Hybrid

About The Position

This position is responsible to ensure compliance with State, CDPHE and Health Care Policy and Financing rules and regulations by examining records, reports, operating practices and documentation and to verify compliance by comparing a list of requirements to the documentation being examined. Appraises adequacy of records and documentation by completing and maintaining a standardized audit tool. Communicate audit findings by preparing reports and discussing findings and/or trends identified with the Quality Assurance Department and entering the data into the QAPI database.

Requirements

Five (5) years of relevant experience in an occupation related to the work assigned to this position OR A combination of related education and/or relevant experience in an occupation related to the work assigned equal to five (5) years.
Full Background
CBI name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure requirements), Drug Screen, PREA (Division of Youth Services), Trails check (direct contact with children), CAPS (direct contact with adults – Mental Health Institutes, Regional Centers, Veterans Community Living Centers).
State of Colorado residency at the time of application (unless otherwise identified in the posting), and residency within the state throughout the duration of employment in this position.
Travel is required to complete regular home audits, attend training, meetings, and run errands as needed.
Former State employees who were disciplinarily terminated or resigned in lieu of termination must: Disclose that information on the application. Explain why the prior termination or resignation should not disqualify you from the current position. Provide your employee number from your prior State employment.
Employment history is calculated on a full-time basis (40/hrs per week). Part-time employment is calculated on a prorated basis to determine qualifications.
Document your work experience/job duties to the extent to which you possess the skills, education, experience, minimum qualifications, and preferred qualifications.
Answer all supplemental questions as your answers to these questions will be evaluated during this phase.
Provide at least 4-8 sentences for each supplemental question.
Answer the supplemental questions completely and thoughtfully. We will rate your answers based on the content of your response and your writing skills (spelling, grammar, and clarity of your writing).

Nice To Haves

Experience working with persons with Intellectual and Developmental Disabilities (IDD).
Experience with data documentation and completion.
Excellent communication skills.
Good work history.
Previous experience supervising, training, coaching, mentoring staff.
Relevant years of state service experience.

Responsibilities

Determines the most efficient routing and scheduling for regular travel to PRC homes to ensure all assigned in-home book audits are completed within the department's established monthly timeline.
Decides which specific rule, regulation, or PRC policy criteria applies when cross-referencing in-home book data to verify program compliance during an audit.
Determines if audited program data falls outside of specified, acceptable state standards and chooses the appropriate standardized reporting method to notify the affected PRC departments.
Conducts quarterly patient account audits by following established review processes and applying state financial criteria to verify institutional billing compliance.
Conducts quarterly in-home book audits within established department timelines, determining the most efficient scheduling, sequencing, and travel routing for assigned regional sites.
Tags, reviews, and clarifies QAPI data utilizing approved department tracking templates, data layouts, and Google Spreadsheet validation formulas to organize raw metrics.
Ensures the maintenance and destruction of physical records by selecting and applying the correct statutory disposal protocol or retention schedule from a range of approved agency policies.
Records destruction documentation and filing using standardized logging methods, indexing layouts, and department-approved tracking mechanisms.
Retrieves records as needed by navigating established agency filing systems and database query parameters to pull requested regulatory files.
Pulls data, reports, and documents from Therap (Electronic Health Record) by executing specific system reporting modules and data filters based on the explicit parameters of the tracking request.
Uploads and maintains consents on Therap by selecting the correct document categorization tag and validation workflow within the electronic health record system to activate client files.
Works with QAPI presenters to ensure data is collected and uploaded properly for monthly QAPI presentations.
Interprets, analyzes, and edits data and presents in the form of tables, charts, spreadsheets, and data summaries.
Conducts trends analysis to identify trends and reason for occurrence.
Establishes action items to be completed in a timely manner to ensure the quality and care of our residents.
Coordinates and schedules monthly QAPI meetings.
Offers suggestions for collection of data and tracking trends for future data collection.
Ensures presentation materials are updated to reflect outcomes as determined by QAPI meeting.
Reviews monthly/Quarterly and year-to-date data to develop reports for use in trending and analysis to identify problems areas and issues for the development of recommendations and solutions.
Completes audits of data as assigned by the Quality Assurance department and reporting/inputting the data into numerous databases for use by the appropriate PRC departments.
Tracks and maintains materials and results by utilizing Excel spreadsheet.
Other Duties as Assigned.

Benefits

PERA Defined Benefit Plan or PERA Defined Contribution Plan plus 401(k) and 457 plans
Medical and dental health plans
Employer supplemented Health Savings Account
Paid life insurance
Short- and long-term disability coverage
11 paid holidays per year plus vacation and sick leave
State of Colorado Employee BenefitHub Resource Center
Employee Wellness program
Excellent work-life programs, such as flexible schedules, training and more
Remote work arrangements for eligible positions
Public Service Loan Forgiveness Program