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About the Role
The Quality Assurance Specialist will conduct audits on clinical records, facilities, and programs both on and off site. This role is responsible for using audit information to improve the overall quality and completeness of clinical documentation, enhance safety, and mitigate risk. The specialist will facilitate audits to ensure compliance with policy, procedure, and regulatory standards, analyze audit results, and prepare reports with data trends and areas for improvement. This role involves ongoing communication with program managers to share findings and contribute to quality improvement efforts, including monitoring corrective action plans and reporting intervention effectiveness.
Responsibilities
- Maintain standards for Confidentiality and 42 CFR/HIPAA.
- Conduct full audits of patient health records and facilities.
- Ensure documentation complies with directives and guidelines of OASAS, OMH, OTDA, DOH/Health Homes, OMIG, DEA, CARF, and other governing, licensing, or accreditation agencies.
- Retrospectively review medical, clinical records, and pertinent documentation according to established site review tools and company policy.
- Use critical thinking to extract, compile, interpret, analyze, and trend data from the electronic health records system and audit tools.
- Communicate data information effectively to stakeholders with varying levels of data literacy.
- Conduct random spot checks on the safety and quality of program environments.
- Utilize Quality Assurance tools and conduct scheduled audits.
- Revise and coordinate tools for upcoming audits.
- Utilize MS Excel to track documentation workflow and provide status reports.
- Use statistical techniques to provide ongoing reports in tables, charts, and graphs.
- Prepare periodic reports on error rates, incidents, training, and other specified criteria.
- Identify billing errors and report them to the supervisor, assisting in communication with the Director of Compliance and Compliance Coordinators.
- Identify and interpret trends in data related to continuous quality improvement.
- Uphold the standards of the agency’s Continuous Quality Assurance Program.
- Participate in assigned meetings.
- Record and produce minutes of Quality Assurance Committee meetings.
- Safeguard and ensure the integrity of all data collected within the assigned department.
- Promote individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.
- Perform other duties as assigned or that may develop.
Requirements
- Must maintain a valid driver's license and acceptable driving record.
Skills
- Proficient in MS Excel and other Microsoft products
- Experience with and ability to effectively use an electronic health record (EHR)
- Essential understanding of process improvement
- Self-managed
- Responsive
- Dedicated to customer service and support
Work Type
- Full-Time
Education Level
- A two-year degree is required, preferred in the field of human services or relevant field; equivalent experience may be considered in lieu of formal education.