QA Specialist Health Homes

Area Agency on Aging & Disabilities of Southwest Washington•Longview, WA

3d•$59,436 - $81,960•Hybrid

About The Position

Conducts AAADSW’s quality assurance and contract monitoring reviews for the Health Home program while consulting with program leadership on ongoing planning and improvement activities; represents HCA for grievances; and serves as the ProviderOne subject matter expert, ensuring program billing is supported in related systems, working closely with the fiscal team and Managed Care partners.

Requirements

Bachelor's degree in social work, health or social science, public administration or a related field.
Two years of experience monitoring records and/or involvement with compliance activities. Equivalent education/experience will substitute for all minimum qualifications except when there are legal requirements, such as a license, certification or registration.
Possession of a valid driver’s license and minimum state-required vehicle insurance and have use of reliable transportation.
Knowledge and experience in reviewing client records and contractor records for compliance.
Ability to collect, analyze and evaluate data and information for program management evaluation.
Ability to manage and complete multiple work projects with quality results in a timely manner meeting identified deadlines.
Ability to use technology including hardware and software applications, the Internet and to learn new applications.
Ability to work independently.
Ability to work effectively as a team member with a wide range of diverse staff and community and to establish and maintain effective working relationships.
Computer and software skills; ability to operate general office equipment; work at a desk using a phone and computer for up to eight hours a day.
Ability to communicate verbally in the English language in face-to-face one-on-one settings, in Team settings, by personal computer, or using a telephone.
Ability to communicate in writing in the English language to generate records for review by administrative law judges and other staff by way of reports, letters, email and notes.
Ability to travel and access client homes and participate in off-site meetings which may not be ADA accessible.

Responsibilities

Conduct quality assurance monitoring for the Health Home program across AAADSW’s regional service area(s), including but not limited to DSNP and CCO audits for all contracted providers.
Communicate and collaborate with the LTSS Director and LTSS Program Manager on compliance monitoring trends by way of report generation and analysis.
Participate as requested in Health Home Lead and CCO network meetings.
Review subcontracted Care Coordination Organizations for contract compliance, in coordination with the Contracts Team.
Collaborate with the LTSS Program Manager on training materials and presentations to the Care Coordination Organization network.
Communicate and problem-solve effectively with colleagues at all levels of the organization.
Co-facilitate HCA’s Health Home in-person training for the network.
Train the CCO network on the HAP Database and provide technical assistance.
Collaborate on requests for public records of Health Home participants.
Serve as the primary liaison for the management of, research on, and communication with fiscal regarding payment discrepancies with Lead entity billing activities.
Confirm CCO billing has the necessary supporting documentation.
Act as the Health Action Plan subject matter expert and provide guidance to staff as needed in data entry in the HAP database.
Review, create, and process reports and documents necessary for HH Lead compliance.
Review, approve, and log CCO network Tier exceptions.