QA Specialist Health Homes

Area Agency on Aging & Disabilities of SW WA•Longview, WA

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 while working closely with the fiscal team and Managed Care partners. The position has no supervisory responsibilities and reports to the Long Term Services and Supports Manager Longview. Work is normally performed in a typical interior office environment. The employee may travel by automobile to meetings or community events and may be exposed to changing weather conditions. The role requires travel to and access to client homes and participation in off-site meetings that may not be ADA accessible. The employee may work at a desk using a phone and computer for up to eight hours a day. A criminal background check will be administered.

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 or experience may substitute for minimum qualifications, except where legal requirements apply.
Valid driver’s license, minimum state-required vehicle insurance, and use of reliable transportation.
Knowledge and experience reviewing client and contractor records for compliance.
Ability to collect, analyze, and evaluate data and information for program management evaluation.
Ability to manage multiple work projects and complete them with quality results by identified deadlines.
Ability to use technology, hardware and software applications, and the Internet, and to learn new applications.
Ability to work independently and effectively as a team member with diverse staff and community members, and to establish and maintain effective working relationships.
Computer and software skills and ability to operate general office equipment.
Ability to work at a desk using a phone and computer for up to eight hours a day.
Ability to communicate verbally in English in face-to-face, team, computer, and telephone settings.
Ability to communicate in written English and generate reports, letters, emails, notes, and records for review by administrative law judges and other staff.
Ability to travel, access client homes, and participate in off-site meetings that may not be ADA accessible.
Ability to meet the physical demands of the job, including regularly talking, hearing, standing, walking, sitting, handling or feeling objects, tools, or controls, and reaching with hands or arms; occasionally lifting or moving up to 20 pounds; and close vision and adjusting focus.

Responsibilities

Conduct quality assurance monitoring for the Health Home program across AAADSW’s regional service areas, including DSNP and CCO audits for contracted providers.
Communicate and collaborate with the LTSS Director and LTSS Program Manager on compliance monitoring trends through report generation and analysis.
Participate in Health Home Lead and CCO network meetings as requested.
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 for the Care Coordination Organization network.
Communicate and problem-solve effectively with colleagues at all levels of the organization.
Co-facilitate HCA’s in-person Health Home training for the network.
Train the CCO network on the HAP Database and provide technical assistance.
Collaborate on public records requests concerning Health Home participants.
Serve as the primary liaison for managing, researching, and communicating with fiscal staff about payment discrepancies involving Lead entity billing activities.
Confirm that CCO billing has the necessary supporting documentation.
Act as the Health Action Plan subject matter expert and guide staff as needed in entering data in the HAP database.
Review, create, and process reports and documents necessary for HH Lead compliance.
Review, approve, and log CCO network Tier exceptions.
Perform other duties as assigned, including work in other functional areas to cover absences, relieve peak workloads, or balance workload.