Quality Improvement Coordinator (2575)

BAKERRIPLEY • Tyler, TX

1d • Onsite

About The Position

The Appeals Specialist gathers and prepares materials for formal appeals, conducts informal reviews, and assists with recoupment efforts when needed. Appeal Specialists communicates with customers to ensure full understanding of appeal requests. Appeal Specialists coordinates with Quality Coordinator II Supervisor and Customer Information and Resource Supervisor on the concerns of the customer’s appeal, reviews for errors, makes recommendations for system improvements. The Appeals Specialist compiles, reviews, and maintains case documentation to support the board appeals process. Expected Positive Outcomes Compiles and prepares materials for customer appeal of termination/denial of services. Conducts informal appeal reviews. Determines if actions taken were within established rules and procedures. Performs fact finding tasks and prepares materials associated with the outcome of appeals hearing, and potential fraud and exception reports. Tracks and reports on all appeals and outcomes of appeals, and on all potential fraud and exception reports. Maintains the confidentiality of case records. Performs other duties as may be assigned. Essential Functions: Researches and compiles responses for various compliance reports. Develops working knowledge of applicable policies, procedures, and processes including local, state, federal and contractual requirements in order to proactively assess assigned organizational compliance. Analyzes repeated staff errors and coordinates actions to assist staff in developing methods to prevent recurrence of errors. Prepares and presents training materials to staff and coaches staff through awareness sessions and specific training to address monitoring findings. Prepares and presents related compliance reports to management identifying areas of noncompliance and maintains complete, organized and accessible compliance records. Maintains a master policy and procedures file in a shared drive database containing policy directives and Workforce Development letters. Conducts quality and compliance inspections of Child Care case files. Develops and utilizes appropriate tools and processes for monitoring consistency. Provides technical assistance to program and administrative staff to document and improve processes; creates and updates process maps and procedures. Additional Responsibilities: Performs other duties as assigned. Complies with all policies and standards.

Requirements

• Associate's Degree and three years’ experience in field related to core duties and responsibilities Required
• Minimum of two years of working knowledge of Child Care Services policies, procedures, and regulatory requirements.
• Intermediate/Advanced analytical skills
• Intermediate/Advanced organizational skills
• Excellent verbal and written communication skills
• Ability to calculate figures and amounts
• Ability to work with others
• Ability to effectively present information and respond to questions both orally and in writing in a manner that is understandable to others
• Ability to generate reports and present findings/recommendations
• Ability to write clear and accurate correspondence and reports
• Ability to fact find with tact, diplomacy and persuasiveness
• Intermediate experience in Microsoft Word, Excel and Outlook

Nice To Haves

• Bachelor's Degree from four-year college or university in field related to core duties and responsibilities and one year of experience, Preferred
• Established professional relationship with Board staff, with ability to collaborate effectively across departments.

Responsibilities

• Gathers and prepares materials for formal appeals.
• Conducts informal appeal reviews.
• Assists with recoupment efforts when needed.
• Communicates with customers to ensure full understanding of appeal requests.
• Coordinates with Quality Coordinator II Supervisor and Customer Information and Resource Supervisor on the concerns of the customer’s appeal.
• Reviews for errors and makes recommendations for system improvements.
• Compiles, reviews, and maintains case documentation to support the board appeals process.
• Determines if actions taken were within established rules and procedures.
• Performs fact finding tasks and prepares materials associated with the outcome of appeals hearing, and potential fraud and exception reports.
• Tracks and reports on all appeals and outcomes of appeals, and on all potential fraud and exception reports.
• Maintains the confidentiality of case records.
• Researches and compiles responses for various compliance reports.
• Develops working knowledge of applicable policies, procedures, and processes including local, state, federal and contractual requirements in order to proactively assess assigned organizational compliance.
• Analyzes repeated staff errors and coordinates actions to assist staff in developing methods to prevent recurrence of errors.
• Prepares and presents training materials to staff and coaches staff through awareness sessions and specific training to address monitoring findings.
• Prepares and presents related compliance reports to management identifying areas of noncompliance and maintains complete, organized and accessible compliance records.
• Maintains a master policy and procedures file in a shared drive database containing policy directives and Workforce Development letters.
• Conducts quality and compliance inspections of Child Care case files.
• Develops and utilizes appropriate tools and processes for monitoring consistency.
• Provides technical assistance to program and administrative staff to document and improve processes; creates and updates process maps and procedures.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED