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About the Role
This is a professional management position responsible for establishing and overseeing quality standards and compliance within the Department of Health, ensuring adherence to County, State, and Federal practices, laws, rules, and regulations. The role involves ensuring compliance with Private Insurances, Medicaid/Medicare rules and policies through staff training, auditing billing submissions, and developing policies for system improvements. The incumbent will be responsible for assessment, policy development, employee training, and adherence to standards set by agency policy, legal mandates, and professional standards of practice. Supervision of subordinate staff may be exercised.
Responsibilities
- Oversees all aspects pertaining to Private Insurances, Medicare/Medicaid regulations, and audits all billing and medical records for proper coding, claim for payments, and billing and payment of services rendered.
- Audits all DOH billing activity for appropriateness with various Federal, State, and Local insurance regulations, including private insurances, Medicaid/Medicare.
- Ensures current credentialing of all DOH providers for billing purposes and ensures in-network contracts are updated periodically.
- Serves as an active member with oversight of the Corporate Compliance Committee and reports all findings of potential violations, investigations, and results of audits, complaints, and violations to the Committee.
- Ensures documentation of education on the compliance plan annually and for all new employees/agents within Community Services, Department of Health, and other related County programs.
- Audits and completes Quality Improvement planning, execution, and leads corrective action planning with all DOH programs, ensuring compliance of all programming within DOH with Federal, State, and Local statutes.
- Maintains documentation of any investigations, corrective action, occurrence screens, and audits in regards to the compliance plan.
- Ensures reporting of meeting minutes, investigation results, and discipline to the Board of Health and Human Services Committee of the Legislature.
- Oversees and coordinates the department’s mandated trainings programs, required individually or in groups per staff job descriptions, grant requirements, or professional need.
- Assists in policy and procedure development, revision, and implementation, and monitors for regulatory changes.
- Reviews and updates all existing DOH policies, procedures, and written plans for accuracy, tracks changes, and creates new policies, procedures, and plans as needed.
- Drafts, reviews, and completes budgets and reconciles budgetary cost center(s) for various DOH programs.
- Ensures compliance and assists Division managers with all grant objectives for filing grant claims and maintaining awareness of grant deadlines.
- May act as HIPAA consultant to advise staff, assure policy and procedure adherence, and report breaches to the Director of Public Health or their designee.
- Maintains awareness of shared community health documents such as CHIP, CHA, and CSP.
- Identifies and facilitates opportunities for public health to contribute to collective efforts.
- Assists divisions in identifying service gaps and aligning current and new programs/activities with community health efforts.
Requirements
- Thorough knowledge of County, State, and Federal practices, laws, rules, and terminology regarding quality assurance and agency compliance.
- Thorough knowledge of modern auditing and accounting methods.
- Thorough knowledge of monitoring and analyzing financial and billing processes necessary to assist with reimbursement.
- Thorough knowledge of public health practices and principles, including population-based health improvement.
- Thorough knowledge of public health accreditation process.
- Good knowledge of quality improvement science and application.
- Ability to create policy and procedures.
- Ability to communicate effectively orally and in writing.
- Ability to plan and administer staff education development.
- Ability to use and request technology systems for accurate, efficient, and secure data management, record keeping, and communication for employee health and educational needs.
- Ability to provide trainings and professional presentations.
- Ability to describe and apply skills of core competencies within the context of the essential public health services.
- Ability to establish and maintain cooperative working relationships.
- Sensitivity to individual client needs with the ability to approach situations and establish policies that take into account diversities and cultural differences.
- Flexibility.
- Sound judgment.
Skills
- Quality Assurance
- Compliance
- Auditing
- Billing
- Medicaid/Medicare Regulations
- Private Insurance Regulations
- Policy Development
- Staff Training
- Data Management
- Record Keeping
- HIPAA
- Budgeting
- Grant Management
Location
- Belmont, NY
Work Type
- Full-time
Experience Level
- Management
- Supervisory
Education Level
- High school diploma or equivalency
- Bachelor's degree
- Associate's degree plus two years of relevant experience
About the Company
- The Department of Health is responsible for establishing and overseeing quality standards and compliance within the organization.