COOK INLET TRIBAL COUNCIL, INC.

JOB DESCRIPTION

 

Job Title:          Quality Assurance Specialist I/II

Department:    Recovery and Reentry Services 

Reports To:      Senior Manager

Supervises:       None 

FLSA Status:    Non-Exempt 

Pay Grade:        N4 (I), N5 (II)

Job Type:          Full-Time, Regular  

AKBCU:             Yes      ICPA: No 

 

 

General Functions:

This position is overseen by the Senior Manager. This position will be responsible for chart reviews, review of services, validating the quality of service delivered, delivery of specific evidenced-based curriculum and practices, ensuring adherence to implementation of specific protocol, weekly quality assurance reports, audit reviews (peer review, billing denials, tracers, and any regulatory audits requests), quality control of downtime documentation and release of information. Support resolution for failed activity tracking and trending.  

 

Duties and Responsibilities:

Quality Assurance Specialist I

Provide a documented chart review of identified billable and non-billable activities including group content, treatment plan, diagnosis, clinical progress notes services and other programs that require specific review identified for adherence to program structure, therapeutic communities and system of care.Audit documentation that is entered into Electronic Health Record(s) for accuracy and identifying common errors to ensure compliance with Commission on Accreditation of Rehabilitation Facilities, National and State accreditations and licensing bodies.   Provide quality assurance reviews within Electronic Health Record(s), to include reviewing the quality-of-service delivery, appropriateness of the services, key components of the evidence-based practices, and frequency of services.   Conduct quarterly, bi-annual and annual review of clinical services, adherence to Continuous Quality Management procedures (CQM) and policy and procedures including fidelity for evidence-based practices when identified and used within the programs.Complete weekly crosschecks, spreadsheets and reports as assigned.Ensures adherence to confidentiality, HIPAA and 42 CFR Part 2 regulationsPerform Release of Information following the HIPAA and 42 CFR Part 2 regulations.   Audit documentation within the Electronic Health Record(s) conform to CITC’s policies and procedures for: peer review, billing denials, tracers, and any regulatory audits requests.Create and maintain downtime documentation in accordance with the Downtime Procedure Policy.Provide clear comprehensive support through face-to-face interactions with staff, email, telephone contacts and webcasted telecommunication (Microsoft Teams, Zoom, etc.).Perform all related duties as assigned.

Quality Assurance Specialist II

Perform all duties and responsibilities of Quality Assurance Specialist I with a higher level of proficiency.Provide ongoing guidance to staff on the Electronic Health Record(s) audit procedures, chart documentation tending reports, and ensuring applications conform to CITC’s policies and procedures.provide quality assurance support to include reviewing failed activity errors for fix request(s).Assist in training new QA Specialist staff on QA procedures and reports.Assist with training Supervisors and Managers on how to review, clinical and non-clinical identify trends in documentation errors and support for correctionsPerform all related duties as assigned.  

 

Job Responsibilities Related to Participant Privacy

Employee is expected to actively participate in CITC privacy training and to protect the privacy of participant information in accordance with CITC's privacy policies, procedures and practices, as required by federal and state law.  Failure to comply with CITC's policies and procedures on participant privacy may result in disciplinary action up to and including termination of employment.Employee may access protected health information and other participant information only to the extent necessary to complete job duties.  Employee may only share such information on a need to know basis with others who have job responsibilities related to treatment, payment, or other CITC operations.Employee is encouraged and expected to report, without the threat of retaliation, any concerns regarding CITC's policies and procedures on participant privacy and any observed practices in violation of the policy to the designated Privacy Officer. 

 

Job Specifications:

Excellent verbal and written communication skills, including face to face communication, email, telephone and webcast telecommunication.Proficient use of personal computers and standard office equipment.Demonstrated ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.Demonstrated ability to work independently with minimal supervision.Demonstrated ability to prioritize workload.Excellent time management skills.Demonstrated ability to coordinate multiple activities.Strong problem-solving skills.Demonstrated ability to work as an active participant in a team environment.Strong group/team facilitation skills.Must have strong writing skills with attention to detail and accuracy of fact reporting.Demonstrated ability to work with individuals from diverse backgrounds.Maintain a positive working relationship with CITC staff.Must maintain confidentiality at all times while displaying a professional disposition.Demonstrated experience working with Alaska Native people, knowledge of their values and belief systems and ability to provide culturally competent services.

 

Minimum Core Competencies: CITC Values, Respectful Leadership, Professionalism, Emotional Intelligence, Problem Solving/Critical Thinking, Communication Skills.

 

Minimum Qualifications:

Quality Assurance Specialist I

Associate’s Degree in Public Health, Human Services, Public Administration, Behavioral Health, or related field.  Relevant experience may substitute for the educational requirement on a year-for-year basis.Minimum of two (2) years’ experience working in healthcare, behavioral health or related field.  Minimum of two (2) years’ experience working with an electronic health record  Minimum of two (2) years’ experience working with evidence-based practices in a healthcare, behavioral health or related field.

 

Quality Assurance Specialist II

Bachelor’s Degree in Public Health, Public Administration, Behavioral Health or related field.  Relevant experience may substitute for the educational requirement on a year-for-year basis. Minimum of three (3) years’ experience working in a health care, behavioral health or related field setting as a quality assurance or supervisor position.Minimum of three (3) years’ experience working in an electronic health record or electronic case management system.Minimum of two (2) years’ experience working with evidence-based practices in healthcare, behavioral health or related field

 

Minimum Qualifications for all Job Levels:

Experience working with Alaska Native people, understanding of their values and belief systems, and ability to provide culturally competent services.Continued employment is contingent upon completion of a satisfactory state and federal fingerprint criminal background check.Ability to work on or offsite, including computer and internet access.

 

Physical Requirements: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

May require prolonged periods of sitting at a desk and consistently working on a computer with repetitive motion.The need to occasionally move around the office to access filing cabinets, storage cabinets, and office equipment may be necessary.Must be able to lift up to 25 pounds occasionally by utilizing proper lifting techniques and working in a safe manner.

 

Disclaimer

The information provided in this description has been designed to indicate the general nature and level of work performed by incumbents within this job.  It is not designed to be interpreted as a comprehensive inventory of all duties, responsibilities, qualifications and working conditions required of employees assigned to this job.  Management has sole discretion to add or modify duties of the job and to designate other functions as essential at any time.  This job description is not an employment agreement or contract.